Adult T-cell leukemia (ATL) is an often aggressive and fatal malignancy of mature CD4+ T lymphocytes, characterized by leukemia, lymphadenopathy, tumor infiltration of the skin, hepatomegaly, hypercalcemia and lytic bone lesions. ATL is an
endemic
disease in southwestern Japan and the Caribbean, but occurs sporadically in most of the world. HTLV-I is recognized as the etiologic agent of adult T-cell leukemia.
We report the 2nd case of ATL in Korea, which was confirmed by typical clinical findings and western blot analysis of the serum. A-44-year-old man was admitted to the Department of Internal Medicine, Kyung Hee University Hospital because of
abdominal
fullness, dyspnea and itching sensation. He denied any history of blood transfusion, drug abuse or travel abroad. On admission, he had multiple lymphadenopathy, hepatomegaly, erythematous nodules on anterior chest wall and both upper extremity,
and
rales on left lower lung fields. His peripheral blood leukocyte count was 287,000/mm3 with 7% atypical lymphocytes containing pleomorphic and lobulated nucleus. In the bone marow, 90% of nucleated cells were leukemic cells. The surface phenotype
of
these abnormal cells were CD2+, CD3+, CD4+, CD5+, CD8-. Anti-HTLV antibody was positive. PCR (polymerase chain reaction) analysis of the DNA from leukemic cells showed HTLV-I provirus integration. Western blotting analysis of patient serum
confirmed
HTLV-I infection. Despite of intensive supportive care, he died of respiratory failure on 21st hospital day.
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