Background:Adult T-cell leukemia/lymphoma (ATL) is caused by human T-cell lymphotropic virus type-1 (HTLV-1). India is considered as a nonendemic region for HTLV-1. Recent upsurge of cases have been noted in southern parts of India.Aims and objectives:The objective was to describe skin manifestations in various types of ATL.Materials and Methods:Clinical examination, blood investigations, skin biopsies, lymph node biopsies, and immunohistochemistry were performed in five patients. Flow cytometry was performed in two cases.Results:Serological testing was positive for HTLV-1 in all patients. All patients presented with skin lesions. Rare presentations of molluscum contagiosum like papules, purpuric macules and plaques, hypopigmented macules and verrucous papules were seen. Dermatophytic infections occurred in two patients. Mucosal lesion was seen in one patient. Histological features include dermal lymphoid infiltrate with or without epidermotropism. Presence of epidermotropism did not correlate with the severity of disease. All patients except one succumbed to illness within few months to 1 year period.Conclusions:ATL manifest in myriad presentations and skin lesions are often the earliest manifestation. Cutaneous manifestations of ATL vary from subtle hypopigmented macules to florid nodular lesions, and HTLV-1 screening need to be carried out in all doubtful cases.

Patients with acute lymphoblastic leukemia (ALL) can develop relapse in sanctuary sites like brain, ovary or testis even when the bone marrow is in remission. Pelvic recurrence is rarely reported during the follow up of successfully treated ALL in females. We report here a very unusual case of a large pelvic lump which the patient herself could feel, that was probably an ovarian relapse of ALL, successfully treated with re-induction chemotherapy alone and achieved complete remission.Keywords ALL Á Relapse Á Ovary Á Malignancy Case History 17 years old female patient diagnosed as acute lymphoblastic leukemia (ALL)-L2, who completed treatment on MCP 841 regime and was on follow up till 1 month prior to the present admission. She first presented to the emergency surgery with abdominal pain which was vague, dull aching and intermittent. There was no vomiting, diarrhoea, fever or constitutional symptoms associated with abdominal pain. She herself was able to palpate a lump in her abdomen.The general physical examination was unremarkable with no lymphadenopathy, pallor, icterus or edema. There was no hepatosplenomegaly, but she had an abdominal mass palpable in the suprapubic and right and left iliac fossa extending up to the right and left lumbar regions and epigastric region with all the features of a mass arising from the pelvis. The lower border of the mass could not be reached as it was extending into the pelvis. Mobility was restricted and had an irregular surface. Ultrasonogram of the abdomen showed lobulated conglomerate abdominopelvic mass lesion with central vascularity reported as Adnexal solid organ mass or possible conglomerate lymphadenopathy. Knowing the clinical background it was most likely the former.Complete haemogram, peripheral smear and bone marrow study at this time did not show any evidence of relapse. CECT abdomen was taken which showed enhancing soft tissue density lesion in pelvis extending to abdomen towards right, the lesion approximately measures 15 9 20 cm with no calcification, uterus and ovaries not separately made out from the lesion (Fig. 1). Bowel loops displaced laterally and superiorly, possibly solid ovarian mass or lymphoid mass.USG guided FNAC of the mass lesion on Giemsa staining showed infiltration by leukaemic cells (Figs. 2, 3, 4). LP study was done to rule out CNS involvement. Surgical and radiotherapy consultations were done. Surgical excision was impossible as the tumor was large with wide extension and infiltration around major blood vessels. Radiotherapy for cyto-reduction also had risk of bowel perforation due to large field of radiation. The only option before us was re-induction with MCP841 regime which was restarted on 18 December 2012. By the time chemotherapy was started the mass was filling almost all of her abdomen.After three doses of L-asparaginase, on day 7 of chemotherapy clinical evaluation revealed decrease in size of mass per abdomen. USG was taken which showed decrease in size of mass to \5 cm. She had L-asparaginase induced pancreatitis after...

Adult T-cell leukemia/lymphoma (ATLL) is an aggressive leukemia/lymphoma of mature T-lymphocytes caused by human T-cell lymphotropic virus type 1 (HTLV-1). At a tertiary healthcare center in South India, a 58-year-old female presented with multiple erythematous, crusted, and umbilicated papules over the body along with cervical lymphadenopathy. The skin biopsy was consistent with cutaneous T-cell lymphoma. Although she responded initially to chemotherapy, the disease relapsed after 3 months, and she developed disseminated infiltrated skin lesions, generalized lymphadenopathy, and leukemia. Due to the unusual clinical findings we did HTLV-1 Enzyme-linked immunosorbent assay (ELISA), which turned out to be positive in high titers. Her mother had died at an early age from a hematological malignancy and her daughter was also found to be seropositive. To the best of our knowledge, this is the first case to be reported from India of the chronic type of ATLL associated with mother-to-child transmission of HTLV-1 in two generations. This case also emphasizes that the chronic type of ATLL can occur in nonendemic areas like India and should be suspected in nonresponding cases of mycosis fungoides. It should be kept in mind that the chronic type often presents without hypercalcemia or the characteristic ‘flower cells’ in the peripheral smear.

<p class="abstract">Cutaneous manifestations observed in COVID-19 include maculopapular rash, urticaria, pseudo chilblain, vesicles, livedo reticularis, petechiae, erythema multiforme-like, symmetric drug related intertriginous and flexural exanthem (SDRIFE)-like and pityriasis rosea-like lesions. Maculopapular rash involving the trunk and sparing palms and soles is the most common cutaneous manifestation reported in COVID-19 patients. We report cutaneous manifestations in six COVID-19 patients from the corona isolation ward and intensive care unit of a tertiary care center for COVID-19 management in Kerala, South India. The skin lesions observed were urticaria (two patients), atypical maculopapular rash with urticarial and erythema multiforme-like lesions, eruptive pseudoangiomatosis, exaggerated insect bite reaction and acute localized exanthematous pustulosis (ALEP)-like lesions. To the best of our knowledge atypical maculopapular rash with urticarial and erythema multiforme-like lesions, eruptive pseudoangiomatosis and acute localized exanthematous pustulosis-like lesions are not reported in COVID-19.</p>

BACKGROUND Plasma cell neoplasms are characterised by clonal proliferation and accumulation of immunoglobulin producing B cells that typically secrete a monoclonal immunoglobulin called M-protein. 1 Multiple myeloma is the commonest of the plasma cell neoplasms with an annual incidence of 1% of all malignancies and 10% of all haematological malignancies. 2 Indian incidence is approximately 6,000 new cases/year. 3 Renal complications develop in 20%-25% of myeloma. 4 Various new methods like cytogenetics and serum β2 microglobulin estimation are ideal in measuring the prognosis of myeloma. 5 But, these are not available in most institutes. So, this study is done to assess the association of prognosis and renal dysfunction in plasma cell neoplasms based on routine clinical, hematological and biochemical variables. MATERIALS AND METHODS Patients were followed up for a maximum period of 3 years to evaluate the prognosis. Renal dysfunction was measured using serum creatinine and blood urea estimation. Statistical Analysis-The data was analysed with the help of computer software SPSS version 18. RESULTS Fifty seven patients were newly diagnosed with plasma cell neoplasms. Male gender, thrombocytopenia, presence of recurrent infections and hyperphosphatemia were associated with bad prognosis. 28% of the study population had renal involvement at presentation. The factors which showed statistically significant association with renal dysfunction were serum calcium and serum phosphate. CONCLUSION Reasonably good assessment of prognosis and risk of renal failure can be made by evaluating routine parameters like gender, platelet count, serum phosphate, serum calcium and the presence of recurrent infections.