Un caso de leucemia cutánea / A case of cutaneous leukemia

Leucemia cutánea es una manisfestación extramedular de Leucemia. La frecuencia y edad de distribución depende del subtipo de leucemia1. Usualmente se presenta después que la enfermedad sistémica se ha manifestado y sugiere recaída o resistencia al tratamiento 11,12. Los hallazgos clínicos y morfológicos tienen una amplia variedad de manifestaciones y se pueden presentar en lesiones nodulares y placas. Raras manifestaciones incluyen máculas eritomatosas, ampollas y úlceras que pueden ocurrir solas o en combinación. A partir de una manifestación solitaria o en grupo, la leucemia cutis puede presentarse con rash eritematoso en un patrón clinicamente polimórfico. Consecuentemente , la leucemia cutánea debe distinguirse de diferentes diagnósticos diferenciales como por ejemplo: metástasis cutáneas o malignidades viscerales, linfoma, erupciones por fármacos, infecciones virales, sifilis, úlceras de varios orígenes. En la mucosa oral, hiperplasia gingival es el principal diagnóstico diferencial.1 El conocimiento de la morfologia clinica es de tremenda importancia en casos en donde la Leucemia no fuera conocida.1 Se presenta el caso poco frecuente de una paciente con diagnóstico de leucemia mieloide aguda que desarrolla una leucemia cutánea durante su seguimiento en Consulta Externa...(AU)

Cutaneous leukemia is an extramedullary manifestation of Leukemia. The frequency and age distribution depends on the subtype of leukemia1. It usually occurs after the systemic disease has manifested and suggests relapse or resistance to treatment 11,12. The clinical and morphological findings have a wide variety of manifestations and can occur in nodular lesions and plaques. Rare manifestations include erythematous macules, blisters and ulcers that can occur alone or in combination. From a solitary or group manifestation, leukemia cutis can present with erythematous rash in a clinically polymorphic pattern. Consequently, cutaneous leukemia must be distinguished from different differential diagnoses such as: cutaneous metastases or visceral malignancies, lymphoma, drug eruptions, viral infections, syphilis, ulcers of various origins. In the oral mucosa, gingival hyperplasia is the main differential diagnosis.1 The knowledge of the clinical morphology is of tremendous importance in cases where the Leukemia was not known.1 The rare case of a patient diagnosed with acute myeloid leukemia is presented that develops a cutaneous leukemia during its follow-up in Outpatient Consultation ... (AU)  

Laboratory characterization of human T cell lymphotropic virus types 1 (HTLV-1) and 2 (HTLV-2) infections in blood donors from Sao Paulo, Brazil.

Serologic screening for human T cell lymphotropic virus types 1/2 (HTLV-1/2) infection in blood donors has been recently introduced in Brazil. Analysis of 351,639 blood donations in Sao Paulo from January 1992 to October 1993 identified 1,063 positive (0.30%) and 2,238 indeterminate (0.63%) samples based on serologic confirmation using a 21e Western blot. A detailed analysis (serologic, molecular, and virologic), based on a laboratory diagnostic algorithm for characterization of HTLV-1 and HTLV-2 infections was undertaken in 50 seropositive or seroindeterminate blood donors. Modified serologic assays (2.3 Western blot that incorporate type-specific recombinant peptides) performed in 29 HTLV-1/2 positive and 21 HTLV-1/2 indeterminate donors with the 21e Western blot identified 25 as infected with HTLV-1, four with HTLV-2, five with untypable HTLV-1/2, 15 as HTLV-1/2 indeterminate, and one as seronegative. Polymerase chain reaction (PCR) analysis using DNA amplification of proviral pol and tax sequences from peripheral blood mononuclear cells confirmed HTLV-1 and HTLV-2 infections in all 2.3 Western blot seropositive donors; of the five serologically untypable donors, three were confirmed to be HTLV-1 positive, one HTLV-2 positive, and one negative by PCR. All of the seroindeterminate donors were also negative by PCR. Furthermore, HTLV-1 could be isolated in cocultures from 10 of 18 infected donors. Cell lines developed from two HTLV-1-infected donors were of T cell phenotype (CD2+, CD3+), exhibiting surface markers of activated CD4 cells (CD4+ CD25+ HLA-DR+). Thus, we provide evidence for the high seroprevalence of HTLV infection in blood donor population in Sao Paulo, Brazil compared with North American donors and propose a comprehensive serologic and genotypic diagnostic algorithm for HTLV-infected donors that has strong implications for counseling of these individuals.

PIP: Blood donors in Brazil have recently begun to be screened for infection with HTLV types 1 and 2. Of 351,639 blood donations screened in Sao Paulo from January 1992 to October 1993, 1063 positive and 2238 indeterminate samples were identified based upon serologic confirmation using the 21e Western blot. Detailed serologic, molecular, and virologic analysis, based upon a laboratory diagnostic algorithm for the characterization of HTLV-1 and HTLV-2 infections, was conducted upon 50 seropositive or seroindeterminate blood donors. 2.3 Western blot serologic assays, which incorporate type-specific recombinant peptides, performed in 29 HTLV 1/2 positive and 21 HTLV 1/2 indeterminate donors with the 21e Western blot identified 25 as infected with HTLV-1, 4 with HTLV-2, 5 with untypeable HTLV 1/2, 15 as HTLV 1/2 indeterminate, and 1 as seronegative. Polymerase chain reaction (PCR) analysis using DNA amplification of proviral pol and tax sequences from peripheral blood mononuclear cells confirmed HTLV-1 and HTLV-2 infections in all 2.3 Western blot seropositive donors. Of the 5 serologically untypeable donors, 3 were found to be HTLV-1-positive, 1 HTLV-2-positive, and 1 negative by PCR. All seroindeterminate donors were also negative by PCR. HTLV-1 could be isolated in cocultures from 10 of 18 infected donors.

HTLV-I associated myelopathy in Salvador (northeastern Brazil).

Recent studies of tropical spastic paraparesis have confirmed the existence of human T-cell leukemia virus type-1 (HTLV-I) in several tropical areas of the world. In order to determine the role of HTLV-I as an etiologic agent of myelopathies in Salvador, we conducted a clinical and serological study in 43 patients with non-traumatic and non-tumoral myelopathies. We found 9 patients with HTLV-I associated myelopathy (HAM) which points to a new endemic area of HAM.

PIP: Human T-lymphotropic virus type one (HTLV-I) exists in several tropical areas of the world and is associated with adult T-cell leukemia/lymphoma and tropical spastic paraparesis. HTLV-I associated myelopathy (HAM) has been described in southern Japan, the US, Colombia, and Central Africa. Several cases have also been identified and described in Brazil. The authors describe the first cases of HAM in Bahia based upon a clinical and serological study in 43 patients with non-traumatic and non-tumoral myelopathies. Sera and CSF of the 43 patients admitted to a general hospital in Salvador over the course of six months with chronic spastic paraparesis were tested for HTLV-I, of whom nine with progressive chronic spastic paraparesis had serum and CSF positive to HTLV-I. These patients were aged 18-56 years. Two were promiscuous and one of them had a blood transfusion eight months before symptoms. They had similar histories with progressive weakness, first in one leg and after in the other which was associated with paresthesias in varying degrees of intensity. None of the patients had sensory level, although all had vegetative disturbances which were characterized by bladder dysfunction, constipation, and impotence in men. These findings suggest the existence of a new area in which HAM is endemic.

HTLV-I associated myelopathy in Salvador (Northeastern Brazil)

Recentes estudos têm mostrado a presença de mielopatia associada a infecçäo por HTLV-I em muitas áreas tropicais do mundo. Com o objetivo de determinar o papel do HTLV-I como agente etiológico de mielopatias em Salvador, realizamos estudo clínico e sorológico em 43 pacientes com mielopatia de etiologia näo traumática e näo tumoral. Encontramos 9 pacientes com mielopatia associada a HTLV-I (HAM) o que sugere nova área endêmica de HAM

Cell surface phenotype and human T lymphotropic virus type 1 antigen expression in 12 T cell lines derived from peripheral blood and cerebrospinal fluid of West Indian, Guyanese and African patients with tropical spastic paraparesis.

Twelve long-term cell lines were established from peripheral blood mononuclear cells (PBMC) or cerebrospinal fluid cells of patients with human T lymphotropic virus type I (HTLV-1) seropositive tropical spastic paraparesis (TSP) originating from the French West Indies, French Guyana or the Central African Republic. Most of these long-term interleukin-2-dependent cell lines exhibited a pattern characteristic of CD4(+)-activated T cells with high expression of CD2, CD3 and CD4 antigens, associated with a strong density of TAC and DR molecules. Nevertheless, in five cases CD8 expression was present at a significant level. HTLV-I antigens were never detected in uncultured PBMC, but they were expressed in a few cells after short-term culture and after 4 months the majority of the cells were HTLV-I positive, as demonstrated by indirect immunofluorescence (IF) using polyclonal or monoclonal anti-p19 and anti-p24 antibodies. Low and variable levels of reverse transcriptase activity were detected in supernatant fluids of these cell lines only after 4 months of culture, when at least 50% of the cells exhibited HTLV-I antigens by IF. However, numerous type C HTLV-I-like viral particles were detected, mostly in the extracellular spaces, with rare budding particles. Similar findings were found in three T cell lines derived from West Indian and African patients with adult T-cell leukaemia/lymphoma (ATLL). Differences in high Mr polypeptides were detected by Western blot in cell lysates when comparing TSP- or ATLL-derived T cell lines. Thus a signal of 62K was easily detectable in all the TSP lines, but not in the ATLL lines. In all cell lines bands corresponding to p53, p24 and p19 viral core polypeptides were present, as was the env gene-coded protein p46.

Cell surface phenotype and human T lymphotropic virus type 1 antigen expression in 12 T cell lines derived from peripheral blood and cerebrospinal fluid of West Indian, Guyanese and African patients with tropical spastic paraparesis

Twelve long term cell lines were established from peripheral blood mononuclear cells (PBMC) or cerebrospinal fluid cells of patients with human T lymphotropic virus type I (HTLV-I) seropositive tropical spastic paraparesis (TSP) originating from the French West Indies, French Guyana or the Central African Republic. Most of these long term interlukin-2-dependent cell lines exhibited a pattern characteristic of CD4+ -activated T cells with high expression of CD2, CD3 and CD4 antigens, associated with a strong density of TAC and DR molecules. Nevertheless, in five cases CD8 expression was present at a significant level. HTLV-I antigens were expressed in a few cells after short-term culture and after 4 months the majority of the cells were HTLV-I positive, as demonstrated by indirect immunofluorescence (IF) using polyclonal or monoclonal anti-p19 and anti-p24 antibodies. Low and variable levels of reverse transcriptase activity were detected in supernatant fluids of these cell lines only after 4 months of culture, when at least 50 percent of the cells exhibited HTLV-I antigens by IF. However numerous type C HTLV-I-like viral particles were detected, mostly in the extracellular spaces, with rare budding particles. Similar findings were found in three T cell lines derived from West Indian and African patients with adult T-cell leukaemia/lymphoma (ATLL). Differences in high M-r polypeptides were detected by Western blot in cell lysates when comparing TSP-or ATLL-derived T cell lines. Thus a signal of 62K was easily detectable in all the TSP lines, but not in the ATLL lines. In all cell lines bands corresponding to p53, p24 and p19 viral core polypeptides were present, as was the env gene-coded protein p46. (AU)