Adult T-cell leukemia/lymphoma with a mixed CD4+ and CD8 + phenotype and indolent course

Abstract

A 9-year-old boy was first examined in January 1991 and reported a history of skin lesions since the age of 7. The patient had multiple small erythematous papules on the outer rims of his ears (Fig 1A) and infiltrated plaques on his upper limbs. Hemogram was within normal limits. Computed tomography scans of the chest and abdomen were normal. A skin biopsy revealed an intense, diffuse infiltration of small, irregular lymphocytes in the dermis and subcutaneous tissue. Some scattered blast cells also were observed. Histology was conclusive for unspecified T-cell peripheral lymphoma. As Bahia State in Brazil is endemic for human T-lymphotropic virus type I (HTLV-I),1 serology for HTLV-I and HIV was investigated. The patient and both parents were HTLV-I seropositive (enzyme-linked immunosorbent assay and Western blot analysis) and HIV negative. Thus, clinical, histological, and laboratory findings were considered compatible with the smoldering type of adult T-cell leukemia/lymphoma (ATL), an aggressive tumor associated with the HTLV-I, generally reported in adults. No treatment was prescribed, and the child was followed up periodically.