Spontaneous Regression Of Pulmonary Infiltration Of Adult T-cell Leukemia/lymphoma

Abstract

A 49-year-old woman was found to have leukocytosis in May 2002, with a white blood cell (WBC) count of 9.8 × 109/L, including 15% atypical lymphocytes with characteristic flower cells.A diagnosis of adult T-cell leukemia/lymphoma (ATLL) in the chronic phase was made on basis of the characteristic cytomorphology, an elevated antibody titer for human T-cell leukemia virus type 1 (HTLV-1), and HTLV-1 viral integration. In November 2005, fine crackles were noted on auscultation of lower lung fields during inspiration, but the patient had no respiratory symptoms. At this time, her WBC count had increased to 20.9 × 109/L, including 20.5% ATLL cells. Chest radiographs and chest computed tomography scans (Figure 1A) were compatible with lymphangitis carcinomatosa in both lower lung fields. Examination of a transbronchial lung biopsy in May 2006 confirmed the infiltration of ATLL cells (Figure 1B) with CD4 antigen (Figure 1C); the patient’s hematologic condition remained in the chronic phase without any specific treatment.The level of soluble interleukin 2 (IL-2) receptor increased to 6520 U/mL. Because the patient has not complained of respiratory symptoms, she is being followed up without any specific treatment for the ATLL. Her radiologic features have gradually improved (Figure 1D) and have been accompanied by a decrease in the soluble IL-2 receptor level (1510 U/mL in January 2007) and a WBC count of less than 10 × 109/L (Figure 1E). ATLL patients commonly have pulmonary complications, of which leukemic pulmonary infiltration is the most frequent, even in chronic and smoldering ATLL. Although many chronic ATLL patients show pulmonary involvement, some do not require any specific treatment for ATLL and may show spontaneous regression of the disease.