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Papers of the Week

2021 Jan 28

BMJ Case Rep



Disseminated cryptococcosis in a patient with newly diagnosed HTLV-1 infection.


Motoa G, Powers H R, Brumble LM
BMJ Case Rep. 2021 Jan 28; 14(1).
PMID: 33509855.


Infection by human T-lymphotropic virus 1 (HTLV-1) is often seen as the cause of chronic infection or lymphoproliferative disorders, but many clinicians do not recognise its association with severe immunosuppression. We report the case of a woman in her 70s from the Caribbean who sought care at the emergency department for weakness, fatigue and weight loss. Further work-up showed atypical lymphocytosis with floral lymphocytes and smudge cells in the peripheral blood smear and hypercalcaemia. Chest CT demonstrated a moderate right pleural effusion. Results of HIV testing were negative, and screening and confirmatory tests for HTLV-1 were positive. Empiric antibiotic therapy was administered, and the patient was discharged home. Five days later, she was readmitted with shortness of breath and severe abdominal pain. A disseminated infection with was diagnosed. Despite aggressive intravenous antifungal therapy, the patient died on day 7 of hospitalisation.