Opportunistic Infections in Patients with HTLV-1 Infection

Abstract

As an acquired immunodeficiency, human immunodeficiency virus (HIV) infection is primarily responsible for opportunistic infections in infected patients. However, opportunistic infections also occur in individuals with human T cell lymphotrophic virus type 1 (HTLV-1) infection. Here, we report opportunistic infections in two Japanese HTLV-1-seropositive patients. The first patient was a 67-year-old male, who had cytomegalovirus infection associated with esophagogastritis and terminal ileitis. The patient was HTLV-1-positive and was diagnosed with smoldering adult T cell leukemia (ATL). High levels of serum soluble IL-2 receptor (sIL-2R; 4,304 U/mL) and an increased percentage of CD4+CD25+ T cells (75.5%) in peripheral blood were also detected. The second patient was a 78-year-old female, a known asymptomatic HTLV-1 carrier, who presented with persistent herpes zoster, followed by Pneumocystis jirovecii pneumonia. Disease progression of smoldering ATL along opportunistic infections was observed with very high levels of serum sIL-2R (14,058 U/mL) and an increased percentage of CD4+CD25+ T cells (87.2%) in peripheral blood. In patients with suspected opportunistic infections, both HTLV-1 and HIV should be considered. In HTLV-1-positive patients, an increase in the CD4+CD25+ T cell subset may have its value as a prognostic marker.

Figure 1

The opportunistic infections in the two HTLV-1-positive patients. (a) Gastric ulcers. (b) Positive staining of cytomegalovirus in a stomach biopsy (original magnification, ×400), from case 1. (c) Chest X-ray and (d) chest computed tomography images of the lungs showing fine nodular shadows and ground glass opacity, from case 2.

Figure 2

Lymphocytes with atypical convoluted nuclei: (a) in case 1 and (b) in case 2 (May-Grünwald-Giemsa stain; original magnification, ×1000).