Abstract
An autopsy case of adult T-cell leukemia with generalized cytomegalovirus infection and pneumocystis carinii pneumonia is reported. The patinet was a 54-year-old man who was born in Yamaguchi prefecture. On admission, he had nodular erythema, soft swelling in bilateral submandibular regions and granular erythema around the neck. The laboratory examinations revealed white blood cell count of 12,300/mm3 with a differential showing 52% atypical lymphocytes with lobulated or convoluted nuclei, of which 96.8% were T cell. Bone marrow specimen also showed mild infiltration of the same atypical lymphocytes (5.3%). Hemoglobin was 12.5g/dl and platelet count was 28.0×104/mm3. Serum immunoglobulins were reduced and IgG was 500mg/dl. From these findings, a diagnosis of adult T-cell leukemia was made. Repeated chemotherapies including cyclophosphamide, vincristine, pepleomycin and adriamycin failed to induce hematological remission, and the patient died of gradually developed respiratory failure. Autopsy disclosed generalized cytomegalic inclusion disease and pneumocystis carinii pneumonia on both sides. Early diagnostic procedures and effective therapy for such refractory infections are required for the management of adult T-cell leukemia.
