Adult T cell leukemia/lymphoma with lymphopenia in a Korean

We experienced a case of adult T cell leukemia/lymphoma (ATLL) in a 48-year -old Korean female, who has never been abroad since birth and no history of blood transfusion. The patient had hypercalcemia and multiple lymphadenopa thy. Histopathologic study of left cervical lymph node (LN) and bone marrow (BM) revealed that infiltrates of malignant lymphoid cells were composed o f small, medium and large cells with pleomorphic nuclei. Smears of peripher al blood (PB) showed lymphopenia (16%) with the appearance of a few atypica l lymphoid cells (less than 2%), but not the typical clover leaf cells seen in ATLL. Immunophenotypic study of LN and BM revealed T cell phenotype. PB showed increased CD4+ T cell (T-H, CD3/CD4+, 57%) and decreased CD8+ T cel l counts (T-S, CD3+CD8+, 6.7%). The sera of the patient and her family were reactive for HTLV-I antibody. The specific sequences of pol, env, and tau of HTLV-I DNA were detected in the lymphoma cells and peripheral blood mono nuclear cells (PBMC) using polymerase chain reaction. Ultrastructural exami nation of PBMC confirmed numerous type c virus particles in extracellular s pace. This case was an acute type of ATLL without overt leukemic features i n PB. Despite chemotherapy and intensive conservative treatment, she died 3 months after admission.