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ATLL — SCE Infectious Diseases MCQ

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ModerateImmunocompromised HostATLLSCE Infectious Diseases

A 45-year-old man with known HTLV-1 infection develops rapidly progressive lymphadenopathy, hypercalcaemia, raised LDH, and abnormal lymphocytes with 'flower cell' morphology on blood film. What is the diagnosis?

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Correct answer: A — Adult T-cell leukaemia/lymphoma (ATLL) — an aggressive T-cell malignancy caused by HTLV-1

ATLL is an aggressive T-cell malignancy occurring in approximately 3–5% of HTLV-1 carriers after decades of latency. The acute form presents with lymphadenopathy, hepatosplenomegaly, skin lesions, hypercalcaemia (through osteoclast activation via PTHrP), raised LDH, and characteristic 'flower cells' (multilobulated lymphocyte nuclei). Prognosis is very poor (median survival <12 months for acute ATLL). Treatment includes combination chemotherapy ± Zidovudine/IFN-alpha (antiretroviral/immunomodulatory approach). Allogeneic HSCT may be considered in younger patients.

Reference: BHIVA 2022 – HTLV-1 guidelines; WHO 2022 – HTLV-1