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March 1, 1995

Human T-Cell Lymphotropic Virus Type I—Associated Adult T-Cell LeukemiaThe Joseph Goldberger Clinical Investigator Lecture

Author Affiliations

From the Metabolism Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md.

JAMA. 1995;273(9):735-737. doi:10.1001/jama.1995.03520330065039

SELECTED CASE  A 37-year-old Jamaican woman developed a generalized erythematous maculopapular rash. She had a peripheral white blood cell (WBC) count of 37×109/L, 75% of which were malignant T cells with convoluted nuclei. The diagnosis of human T-cell lymphotropic virus type I (HTLV-I)—related adult T-cell leukemia/lymphoma (ATL) was supported by high titers of antibodies to HTLV-I in the peripheral blood. The patient was referred to the National Institutes of Health for treatment.Results of physical examination on admission were normal, with the exception of a generalized nonpuritic maculopapular skin rash. The patient manifested overt leukemia with a peripheral WBC count of 32.6 ×109/L, 83% of which were malignant T cells. The phenotype of the malignant cells was CD3+, CD4+, CD8-, CD7-, and CD25+. The serum concentration of soluble CD25 was elevated to 3645 units (normal geometric mean 235, with 95% confidence interval of 112 to 502

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