Multiple polypoid lesions with erosion of the gastric mucosa in adult T-cell lymphoma/leukemia superimposed on cytomegalovirus infection

[摘要] We report here unique endoscopic findings of cytomegalovirus(CMV) gastritis associated with adult T-cell leukemia/lymphoma(ATLL). A 67-year-old Japanese man presented to a hematologistwith a month history of appetite loss. Physical examination showedblurred consciousness (GCS E4V2M5) with labored breathing andhypotension. Blood examination revealed hypercalcemia (adjustedCa: 3.24 mmol/L), anemia (Hb: 70 g/L), and leukocytosis (whiteblood cell count: 21.3 × 109/L) with abnormal lymphocytes (7%).Human T-cell lymphotropic virus type 1 antibody and provirus DNAmonoclonality were positive. A blood transfusion was given, andnoradrenaline and denosumab were administered. Upper gastrointestinal tract endoscopy showed multiple polypoid lesions withredness and erosive surface (upper left; see Figure 1). A gastricbiopsy specimen showed the presence of CD3+CD4+CD8− T cells,compatible with the gastric involvement by ATLL, and CMV gastritispresenting with inclusion bodies positive for anti-CMV antibody byimmunohistochemistry (upper right and lower left; see Figure 1).

[关键词] cytomegalovirus;HTLV-1;malignant lymphoma