TENOSYNOVIAL NODULOSIS IN A PATIENT INFECTED WITH HUMAN T-CELL LYMPHOTROPIC VIRUS-I

We describe a 45-year-old man who presented with multiple nodules alon g the tendons of the scapular region, the elbows, wrists, forearms, th ighs, and ankles, The patient was a carrier of human T cell lymphotrop ic virus I (HTLV-I), which was probably transmitted from his mother; h is mother also had polyarthritis. Histopathologically, the nodules con sisted of numerous, small, fibrinoid masses, The synovium adjacent to the tendon sheath was hyperplastic, with fibrinoid necrosis mimicking rheumatoid synovium, However, synovitis was not present inside the adj acent joint, HTLV-I proviral DNA was detected in the cells of the nodu le, in tenosynovial cells, and in peripheral blood lymphocytes, but no t in skin fibroblasts, In situ reverse transcription assay showed a hi gh quantity of tax/rex messenger RNA in the proliferating lining cells , Based on these features, we classified this case as an atypical mani festation of HTLV-I-associated arthropathy associated with fibrinoid n odules resulting from chronic tenosynovitis.