A case of smolding adult T-cell leukemia with pneumocystis carinii and strongyloides stercoralis within bronchoalveolar lavege fluid and sputum

Abstract

We report a case of smoldering adult T-cell leukemia (ATL) complicated by Pneumocystis carinii (P. carinii) and strongyloidiasis.
The patient was a 48-year-old woman, complaining of cough, sputum, general malaise and weight loss. Chest Xray and computerized tomography (CT) revealed diffuse fine granular shadows throughout both lung fields. Therefore, hypersensitivity pneumonitis was initially considered. P. carinii pneumonia was demonstrated by Grocott staining and immunoperoxidase for the BAL fluid specimen. After two weeks, strongyloides sterocoralis was detected by sputum cytology and was confirmed in the stool.
Immunodificiency was suspected and, finally, the patient was diagnosed as having smoldering ATL, based on a detailed clinical examination which showed HTLV-I antibody in serum and atypical lymphocytes with convoluted nuclei including the so-called “flower cell”.