ATYPICAL HUMAN T-CELL LYMPHOTROPIC VIRUS TYPE-I-ASSOCIATED T-CELL LYMPHOMA IN A LOW-PREVALENCE ALASKA NATIVE POPULATION - IMPLICATIONS FOR DISEASE SURVEILLANCE

An atypical case of adult T-cell leukemia/lymphoma (ATL) associated wi th human T-cell lymphotropic virus type I (HTLV-I) occurred in a 46-ye ar-old Inupiat Eskimo man with no behavioral risk factors for HTLV-I i nfection. The case was characterized by lack of atypical circulating l ymphocytes, hypercalcemia, and opportunistic infections; and by comple te remission of the initial renal parenchymal lymphoma. The lymphoma c ells had a helper T-cell (CD4) immunophenotype. Serum antibodies to HT LV I/II, detected by Western immunoblot, were identified in specimens collected 31 months before the onset of illness, at the time of diagno sis, and up to 37 months later, shortly before the patient's death. Po lymerase chain reaction was used to identify HTLV-I DNA in peripheral blood mononuclear cells and in lymphoma in involved skin. Clinicians s hould be alert to sporadic cases of both atypical and classic ATL, eve n in populations in which the prevalence of HTLV-I infection is low.