Chronic Adult T-cell Leukemia with T4 and T8 Positive Leukemic Cells Associated with Central Diabetes Insipidus

Abstract

A case of chronic adult T-cell leukemia (ATL) with T4 and T8 positive leukemic cells associated with central diabetes insipidus was reported.
A 39-year-old man was admitted to the hospital because of left pleural effusion in February 1981. Pleural effusion and peripheral blood revealed atypical lymphocytes with convoluted nuclei. A diagnosis of leukemic T-cell malignant lymphoma was made. Pleural effusion was improved by VEP-therapy but examination of blood smear showed constantly 10∼20% atypical lymphpcytes. He was re-admitted because of general fatigue, shortness of breath, polydipsia and polyuria. Chest X-ray showed pleural effusion. The leukocyte count in peripheral blood was 30,900/cmm with 46.5% atypical lymphocytes. The examination of leukemic cell surface markers showed OKT3 37.6%, OKT4 70.7%, OK8 60.7%, OKT11 87% in peripheral blood: OKT3 20.9%, OKT4 81.4%, OKT8 78.8%, OKT 11 94.9% in pleural effusion, indicating that the ATL cells of this patient have both T4 and T8 antigens. The diagnosis of ATL with T4 and T8 was made, because anti-ATLA (adult T-cell leukemia associated antigen) antibody was positive and the integration of HTLV-I (human T-cell lymphotropic virus-I) in the DNA of the leukemic cells was demonstrated.
Urine volume was about 5 litter daily and specific gravity was 1.006. Vasopressin test was positive. Dehydration test and Carter-Robbins test established the diagnosis of central diabetes insipidus. Skull X-ray and brain CT showed normal appearance, and the levels of other pituitary hormones were normal. Diabetes insipidus was treated by 1-deamino-8-arginine vasopressin (DDAVP) and the therapy was effective.