Human T-cell Lymphotropic Virus Type-1 (HTLV-1)-associated Bronchioloalveolar Disorder Presenting with Mosaic Perfusion

Abstract

Human T-cell lymphotropic virus type-1 (HTLV-1)-associated bronchioloalveolar disorder (HABA) is a specific state with chronic and progressive respiratory symptoms caused by bronchiolar or alveolar disorder characterized by smoldering adult T-cell leukemia or the HTLV-I carrier state. We herein report a rare case of HABA with an initial presentation of mosaic perfusion in the lung. The diagnosis was made according to the results of a flow cytometry analysis of the bronchoalveolar lavage fluid and pathological findings. Clinicians must be careful to recognize that mosaic perfusion may be a radiological finding of HABA.

Extracellular Vesicles in HTLV-1 Communication: The Story of an Invisible Messenger

“…A series of studies has shown the relationship between HTLV-1 and pulmonary diseases. Specifically, HAM/TSP patients displayed lymphocytic inflammation [180][181][182] and changes in CT scan images [183][184][185]. Severe lung damage is predominantly observed in HTLV-1-associated inflammatory diseases such as HAM/TSP and uveitis due to the presence of high CD4 + CD25 + T lymphocytes, release of cytokines (i.e., IL-2, IL-12, and IFN-γ), inflammatory chemokines (i.e., MIP-1α and IP-10), and expression of ICAM-1 in the bronchioalveolar lavage fluid (BALF) [127,186].…”

Human T Lymphotropic Virus and Pulmonary Diseases

“…The HTLV-1 proviral load in the BALF seems to be related with the proportion of lymphocytes in the BALF too ( Desgranges et al, 1989 ). Besides that, the higher percentages of CD4+ and CD25+ in the BALF than in peripheral blood ( Seki et al, 2000 ) suggests that HTLV-1 infection could induce chronic inflammation in the lung, through immunologic mechanisms ( Yamakawa et al, 2015 ). It seems that this exacerbated immune response that occurs in HTLV-1 infected patients may play a key role in the development of lung injury.…”

“…We show that may be a relationship between HTLV-1 infection and changes in pulmonary function, especially in individuals with HAM/TSP, which may progress to obstructive or restrictive lung disease, possibly related to pulmonary inflammation ( Normando et al, 2016 ; Falcão et al, 2017 ). A previous study observed obstructive disease in a suspect patient of bronchiolitis obliterans that was identified as HTLV-1 associated bronchioloalveolar disorder (HABA) with 1.25 l forced expiration volume in one second (FEV 1 ) (74.4% of predicted) and 64.1% forced expiratory volume in one second/forced vital capacity (FEV 1 /FVC) ( Yamakawa et al, 2015 ) due Adult T-cell leukemia ( Kimura, 1992 ).…”

“…A relationship between HTLV-1 and pulmonary diseases was established with reports of individuals with TSP/HAM who exhibit pulmonary diseases with characteristics of lymphocytic inflammatory infiltrate ( Sugimoto et al, 1987 ) and later by other authors ( Teruya et al, 2008 ; Kawabata et al, 2012 ; Nakayama et al, 2013 ), include opportunistic pulmonary infections ( Taylor and Matsuoka, 2005 ) and alterations in CT images in infected individuals ( Kikuchi et al, 1996 ; Tateishi et al, 2001 ; Kadota et al, 2004 ; Okada et al, 2016 ; Einsiedel et al, 2014 ; Yamakawa et al, 2015 ; Falcão et al, 2017 ).…”