Adult T-cell leukaemia/lymphoma in a patient with pulmonary tuberculosis and Norwegian scabies

Acute adult T-cell leukaemia (AATL) is a clinical subtype of adult T-cell leukaemia/lymphoma, a rare type of peripheral T cell lymphoma. It is associated with infection by the retrovirus Human T-Lymphotropic Virus Type-1 (HTLV-1), and is seen most commonly in HTLV-1 endemic areas. The tumour cells have polylobulated nuclei morphologically and are CD3+, CD4+ or CD8+, CD7-, express T-cell receptor , and are CD25+. The disease has an aggressive clinical course associated with marked immunosuppression caused by HTLV-1, and a poor prognosis. We report a rare case of a young male patient who presented with AATL complicated by multiple opportunistic infections including pulmonary tuberculosis and Norwegian scabies. He also had chronic hepatitis B. This constellation of illnesses has not previously been reported from South Africa in a population where another retrovirus, Human Immunodeficiency Virus (HIV), is a far more common occurrence, as are the HIV-related lymphomas.