Tuberculosis (TB) is a major public health problem worldwide and a large number of fatal cases are still reported. Immunocompetent individuals are naturally susceptible to TB, and immunocompromised patients have a greater risk of infection. Although patients with adult T-cell leukemia/lymphoma (ATL) are in an immunosuppressed condition, there is only one reported case of TB accompanied with ATL in the English- language literature in the field of dermatology. Here, we report two patients with chronic-type ATL infected with TB manifesting as cutaneous solitary masses. Case 1 was a 58-year-old woman diagnosed with lumbar abscess with pulmonary TB. Case 2 was an 84-year-old woman diagnosed with tuberculous lymphadenitis in the left cervical region. It is important to raise the differential diagnosis of TB and perform tissue culture for acid-fast bacilli as well as Interferon-Gamma release assay test when dermatologists encounter mass lesions in patients with ATL.
References
[1]
Ohshima, K., Jaffe, E.S. and Kikuchi, M. (2008) Adult T-Cell Leukemia/Lymphoma. In: Swerdlow, S.H., Campo, E., Harris, N.L., et al., Eds., WHO Classification of Tumors of Haematopoietic and Lymphoid Tissues, 4th Edition, IARC, Lyon, 281-284.
[2]
Tokura, Y., Sawada, Y. and Shimauchi, T. (2014) Skin Manifestations of Adult T-Cell Leukemia/Lymphoma: Clinical, Cytological and Immunological Features. The Journal of Dermatology, 41, 19-25. http://dx.doi.org/10.1111/1346-8138.12328
[3]
Kabashima, R., Kabashima, K., Hino, R., Shimauchi, T. and Tokura, Y. (2008) Scabies Superimposed on Skin Lesions of Adult T-Cell Leukemia/Lymphoma: Case Report and Literature Review. International Journal of Dermatology, 47, 1168-1171.
http://dx.doi.org/10.1111/j.1365-4632.2008.03707.x
[4]
Dantas, L., Netto, E., Glesby, M.J., Carvalho, E.M. and Machado, P. (2014) Dermatological Manifestations of Individuals Infected with Human T Cell Lymphotropic Virus Type I (HTLV-I). International Journal of Dermatology, 53, 1098-1102.
http://dx.doi.org/10.1111/ijd.12170
[5]
Qayyum, S. and Choi, J.K. (2014) Adult T-Cell Leukemia/Lymphoma. Archives of Pathology & Laboratory Medicine, 138, 282–286. http://dx.doi.org/10.5858/arpa.2012-0379-RS
[6]
Amano, M., Setoyama, M., Grant, A. and Kerdel, F.A. (2011) Human T-Lymphotropic Virus 1 (HTLV-1) Infection-Dermatological Implications. International Journal of Dermatology, 50, 915-920. http://dx.doi.org/10.1111/j.1365-4632.2011.04882.x
[7]
Marsh, B.J. (1996) Infectious Complications of Human T Cell Leukemia/Lymphoma Virus Type I Infection. Clinical Infectious Diseases, 23, 138-145.
http://dx.doi.org/10.1093/clinids/23.1.138
[8]
Khader, S.A., Bell, G.K., Pearl, J.E., et al. (2007) IL-23 and IL-17 in the Establishment of Protective Pulmonary CD4+ T Cell Responses after Vaccination and during Mycobacterium tuberculosis Challenge. Nature Immunology, 8, 369-377. http://dx.doi.org/10.1038/ni1449
[9]
North, R.J. and Jung, Y.J. (2004) Immunity to Tuberculosis. Annual Review of Immunology, 22, 599-623. http://dx.doi.org/10.1146/annurev.immunol.22.012703.104635
[10]
Cooper, A.M. and Khader, S.A. (2008) The Role of Cytokines in the Initiation, Expansion, and Control of Cellular Immunity to Tuberculosis. Immunological Reviews, 226, 191-204.
http://dx.doi.org/10.1111/j.1600-065X.2008.00702.x
[11]
Kobashi, Y., Abe, M., Mouri, K., Obase, Y., Miyashita, N. and Oka, M. (2012) Usefulness of Tuberculin Skin Test and Three Interferon-Gamma Release Assays for the Differential Diagnosis of Pulmonary Tuberculosis. Internal Medicine, 51, 1199-1205.
http://dx.doi.org/10.2169/internalmedicine.51.5703
[12]
Singh, A., Dey, A.B., Mohan, A., Sharma, P.K. and Mitra, D.K. (2012) Foxp3+ Regulatory T Cells among Tuberculosis Patients: Impact on Prognosis and Restoration of Antigen Specific IFN-γ Producing T Cells. PLoS One, 7, e44728.
http://dx.doi.org/10.1371/journal.pone.0044728
[13]
Scott-Browne, J.P., Shafiani, S., Tucker-Heard, G., et al. (2007) Expansion and Function of Foxp3-Expressing T Regulatory Cells during Tuberculosis. The Journal of Experimental Medicine, 204, 2159-2169. http://dx.doi.org/10.1084/jem.20062105
[14]
Hamada, M., Urabe, K., Moroi, Y., et al. (2004) A Case of Multifocal Lupus Vulgaris That Preceded Pulmonary Tuberculosis in an Immune Compromised Patient. The Journal of Dermatology, 31, 124-128. http://dx.doi.org/10.1111/j.1346-8138.2004.tb00521.x
