MULTIPLE ORGAN FAILURE ASSOCIATED WITH EXTENSIVE METASTATIC CALCIFICATION IN A PATIENT WITH AN INTERMEDIATE STATE OF HUMAN T-LYMPHOTROPIC VIRUS TYPE-I (HTLV-I) INFECTION - REPORT OF AN AUTOPSY CASE

A patient with an intermediate state of human T lymphotropic virus typ e I (HTLV-I) infection and in whom autopsy showed multiple organ failu re (MOF) associated with extensive metastatic calcification in systemi c organs is described. A 56-year-old man presented with signs and symp toms of advanced cardiac insufficiency, respiratory disturbance and re nal failure. Serologically, the anti-human T lymphotropic virus type I (HTLV-I) antibody titer and the levels of both calcium and parathyroi d hormone-related peptide (PTHrP) were distinctly elevated. These data suggested a diagnosis of adult T cell lymphoma/leukemia (ATLL), Howev er, examination of a peripheral blood sample revealed only a few atypi cal lymphoid cells (3%) associated with mild leukocytosis (white blood cell count, 13.7 x 10(3)/mm(3)), Lymph node swelling was systemic but mild, with some nodes up to 10 mm in diameter. The patient died of MO F, Adult T cell leukemia/lymphoma was unable to be diagnosed definitiv ely because of the short duration of laboratory abnormalities and beca use of the discrepancy between the laboratory data and the magnitude o f lymphoproliferation in both the lymph nodes and peripheral blood. At autopsy, the most conspicuous finding was extensive metastatic calcif ication in the multiple organs, including the heart, lungs, kidneys, t ongue, liver, pancreas, spleen and systemic arterial walls. Very small numbers of medium-sized atypical lymphoid cells admired with small re active lymphocytes were identified in multiple organs, with no evidenc e of massive infiltration. Molecular analyses could not detect monoclo nal integration of HTLV-I provirus DNA or monoclonality of T cell line age cells. Parathyroid hormone-related peptide was demonstrated in the cytoplasm of the atypical lymphoid cells on immunohistochemical exami nation. The bone trabeculae generally showed distinct evidence of reso rption associated with marked proliferation of osteoclasts, These find ings suggested that the hypercalcemia in the present case was categori zed as humoral hypercalcemia of malignancy rather than local osteolyti c hypercalcemia.