リウマチ様関節炎に対する免疫抑制療法中に発症した成人T細胞性白血病/リンパ腫の1例

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タイトル別名
  • ショウレイ ホウコク(ダイ18カイ ワカテ ショウレイショウ ジュショウ ロンブン) リウマチ ヨウ カンセツエン ニ タイスル メンエキ ヨクセイ リョウホウ チュウ ニ ハッショウ シタ セイジン Tサイボウセイ ハッケツビョウ/リンパシュ ノ 1レイ
  • Development of adult T-cell leukemia/lymphoma during immunosuppressive therapy for human T-cell leukemia virus type 1 associated arthropathy
  • HTVL‐1キャリアへの免疫抑制療法中に発症したATLL

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抄録

A 64-year-old woman presented with lower leg edema, fever, and bilateral joint pain, involving the wrists, fingers, and knees, in April 201X. Serological test results were negative for rheumatoid factor, antinuclear antibody, and anti-cyclic citrullinated peptide antibody. A diagnosis of remitting seronegative symmetrical synovitis with pitting edema syndrome, a type of seronegative rheumatoid arthritis, was made and prednisolone was administered. The joint pain was refractory to prednisolone therapy. In February, 201X+2, the patient presented with right cervical lymphadenopathy. The CT scan revealed swelling of the cervical, axillary, and inguinal lymph nodes bilaterally and rapidly enlarged. In April, 18F-fluorodeoxyglucose PET/CT scan showed an abnormal collection in the enlarged lymph nodes. The patient subsequently developed hoarseness with dyspnea and attended our department. Blood test results showed high levels of lactate dehydrogenase (547U/L) and soluble interleukin‐2 receptor (34200 IU/L) and were positive for anti-human T-cell leukemia virus type1 (HTLV‐1) antibody. Biopsy of the right cervical lymph node showed proliferation of abnormal lymphoid cells positive for CD3, CD4, and CD25 and negative for CD7. Monoclonal integration of HTLV‐1 proviral DNA was detected in the lymph node. A diagnosis of adult T-cell leukemia/lymphoma (ATLL), lymphoma type was made. The pain involving multiple joints was attributed to HTLV‐1associated arthropathy. Immunosuppressive therapy for HTLV‐1 carrier status may have played a role in the development of ATLL.

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