A Case of Adult T-cell Leukemia with Massive Intestinal Involvement presenting Severe Diarrhea as Chief Symptom

Abstract

A 38-year-old man diagnosed as adult T-cell leukemia was described. He had watery diarrhea for two months and was isolated in our hospital because of the identification of Shigella sonnei. Despite the treatment with antibiotics sensitive to it, his symptoms worsend progressively. Blood examination revealed lymphocytosis; the most lymphocytes had deeply indented and lobulated muclei and rosetted spontaneously with sheep erythrocytes. Pseudopolyposis was revealed in the small and large intestine by barium enema and/or fiberscope. Light and electron microscopic exmainations of materials from large bowel revealed the infiltration of the leukemic cells into the entire mucous membrane. The treatment with dexamethasone and cyclophosphamide was unsuccessful.
Monoclonal antibodies characterized the phenotype of leukemic cells as helper/inducer T cells (namely OKT₃⁺, OKT₄⁺ and Leu 3a⁺). However the leukemic cells also reacted with OKT₈ and Leu 2a, which are markers of cytotoxic/suppressor T cells.
The clinical and immunocytological chracteristics were discussed.