A 73-year-old woman with history of left breast cancer surgery suffered from dyspnea. She was bone in Oita prefecture, Japan. Laboratory findings revealed an elevated lactate dehydrogenase level (1,063 U/L), while the soluble interleukin (IL)-2 receptor level had also increased (164,840 U/mL). Human T cell leukemia virus type I (HTLV-1) antibody was detected, whereas no abnormal lymphocytes were found in peripheral blood. A chest X-ray revealed left-sided massive pleural effusion (Picture 1). Chest computed tomography revealed an enlarged mediastinal lymph node. Many abnormal lymphocytes with a flower-cell morphology were found in the pleural effusion (Picture 2). A Southern blot analysis of them detected the integration of the HTLV-1 proviral DNA. HTLV-1 had been suspected to have been transmitted through breast feeding. Pleural effusion due to acute adult T cell leukemia/Lymphoma (ATLL) was diagnosed. The pleural effusion remarkably decreased after receiving 8 weeks of chemotherapy for ATLL. ATLL commonly involves leukemic infiltrates in a variety of organs. Although pleural effusion has been recognized as a manifestation of acute-type ATLL, the present case did not demonstrate most of the general features of acute-type, such as a rapid course with leukemic manifestation ( ≥ 2% ATL cells), lymphadenopathy, hepatosplenomegaly, skin involvement and hypercalcemia (1,2). For clinicians, it is important to consider the possibility of ATLL in patients presenting with pleural effusion in HTLV-1 endemic areas in Japan.
Picture 1.
Picture 2.
The authors state that they have no Conflict of Interest (COI).
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