Atypical presentation of adult T-cell leukaemia/lymphoma due to HTLV-1: prurigo nodularis lasting twelve years followed by an acute micropapular eruption

Acta Derm Venereol. 2010 May;90(3):287-90. doi: 10.2340/00015555-0846.

Abstract

Prurigo nodularis is a pruritic dermatosis of unknown origin. Human T-cell lymphotropic virus type 1 (HTLV-1) causes adult T-cell leukaemia/lymphoma. HTLV-1 is not considered to be a cause of prurigo nodularis. A 52-year-old black man, from the French West Indies, who had had prurigo nodularis for 12 years, presented with a distinct micropapular eruption with the typical pathological picture of epidermotropic T-cell lymphoma. Based on HTLV-1-positive serology and monoclonal integration of HTLV-1 we diagnosed smouldering adult T-cell leukaemia/lymphoma. Re-examination of previous skin biopsies revealed that the disease had been evolving for 12 years. Treatment with alpha-interferon, 3 x 106 units three times a week, associated with zidovudine, 1 g daily, resulted in complete remission within 4 months. When investigating a prurigo nodularis, we therefore recommend: (i) performing HTLV-1 serology if the patient comes from an endemic area; (ii) if positive, performing CD25 staining and looking for a HTLV-1 clonal integration; and (iii) if positive, using a treatment targeting HTLV-1.

Publication types

  • Case Reports

MeSH terms

  • Anemia, Refractory, with Excess of Blasts / drug therapy
  • Anemia, Refractory, with Excess of Blasts / pathology
  • Anemia, Refractory, with Excess of Blasts / virology*
  • Antineoplastic Agents / therapeutic use
  • Antiviral Agents / therapeutic use
  • Biopsy
  • CD4-Positive T-Lymphocytes / immunology
  • CD4-Positive T-Lymphocytes / virology
  • Human T-lymphotropic virus 1 / genetics
  • Human T-lymphotropic virus 1 / immunology
  • Human T-lymphotropic virus 1 / pathogenicity*
  • Humans
  • Interferon alpha-2
  • Interferon-alpha / therapeutic use
  • Interleukin-2 Receptor alpha Subunit / analysis
  • Leukemia-Lymphoma, Adult T-Cell / complications
  • Leukemia-Lymphoma, Adult T-Cell / diagnosis*
  • Leukemia-Lymphoma, Adult T-Cell / drug therapy
  • Leukemia-Lymphoma, Adult T-Cell / immunology
  • Male
  • Middle Aged
  • Prurigo / drug therapy
  • Prurigo / immunology
  • Prurigo / pathology
  • Prurigo / virology*
  • Recombinant Proteins
  • Skin / immunology
  • Skin / pathology
  • Skin / virology*
  • Time Factors
  • Treatment Outcome
  • Zidovudine / therapeutic use

Substances

  • Antineoplastic Agents
  • Antiviral Agents
  • IL2RA protein, human
  • Interferon alpha-2
  • Interferon-alpha
  • Interleukin-2 Receptor alpha Subunit
  • Recombinant Proteins
  • Zidovudine