Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Case Study
  • Published:

A case of human T lymphotropic virus type I-associated synovial swelling

Nature Clinical Practice Rheumatology volume 3, pages 675–680 (2007)Cite this article

Abstract

Background Human T lymphotropic virus type 1 (HTLV-I) is associated with T-cell activation, proliferation, and leukemogenesis. HTLV-I is the causative agent of adult T cell leukemia/lymphoma and is associated with myelopathy/tropical spastic paraparesis, uveitis, polymyositis, synovitis, thyroiditis, and bronchoalveolar pneumonia. Since T-cell abnormalities are present in those infected with HTLV-I, the clinical problems might result from abnormal immune function or from direct leukemic or lymphomatous cell infiltration of tissues in the body. Distinguishing between these potential causes might be difficult in patients with joint involvement since the clinical findings can be similar. Consequently, obtaining synovial tissue for analyses is likely to be helpful in determining which process is causing the clinical symptoms.

Investigations Physical examination, comprehensive metabolic panel, complete blood counts, urinalysis, serological testing for rheumatoid factor, antinuclear antibodies, hepatitis, and cytomegalovirus; western blot for HTLV-I/II, lymphocyte phenotyping of peripheral blood, polymerase chain reaction, plain radiographic imaging, CT, MRI skin biopsy with immunohistochemical analysis, lymph node biopsy with immunohistochemical analysis, lymphocyte phenotyping of synovial fluid, synovial tissue biopsy with immunohistochemical analysis of synovial tissue, and synovial tissue culture.

Diagnosis HTLV-I infected synovial cells in conjunction with leukemic/lymphomatous infiltration of synovial tissue.

Management Chemotherapy protocol using alemtuzumab.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Photography and radiography of the patient's hands and wrists at referral.
Figure 2: MRI of the patient's right wrist.
Figure 3: Immunohistochemical analysis of synovial tissue from the biopsy specimen of the right wrist.
Figure 4: PET scans of the patient's wrists and hands following injection with approximately 15 mCi 18F-FDG.

References

  1. Hinuma Y (1985) A retrovirus associated with a human leukemia, adult T-cell leukemia. Curr Top Microbiol Immunol 115: 127–141

    CAS  PubMed  Google Scholar 

  2. Watanabe T (1997) HTLV-1 associated diseases. Int J Hematol 66: 257–278

    Article  CAS  Google Scholar 

  3. Haynes BF et al. (1983) Identification of human T cell leukemia virus in a Japanese patient with adult T cell leukemia and cutaneous lymphomatous vasculitis. Proc Natl Acad Sci USA 80: 2054–2058

    Article  CAS  Google Scholar 

  4. Harden EA et al. (1984) Leukemia-associated arthritis: identification of leukemic cells in synovial fluid using monoclonal and polyclonal antibodies. Arthritis Rheum 27: 1306–1308

    Article  CAS  Google Scholar 

  5. Sato K et al. (1991) Arthritis in patients infected with human T cell lymphotropic virus type I. Clinical and immunopathologic features. Arthritis Rheum 34: 714–721

    Article  CAS  Google Scholar 

  6. McCallum RM et al. (1997) Arthritis syndromes associated with human T cell lymphotropic virus type I infection. Med Clin North Am 81: 261–276

    Article  CAS  Google Scholar 

  7. Taniguchi A et al. (1988) Adult T cell leukemia presenting with proliferative synovitis. Arthritis Rheum 31: 1076–1077

    Article  CAS  Google Scholar 

  8. Eguchi K et al. (1991) A case of adult T cell leukemia complicated by proliferative synovitis. J Rheumatol 18: 297–299

    CAS  PubMed  Google Scholar 

  9. Giam CZ and Jeang KT (2007) HTLV-I Tax and adult T-cell leukemia. Front Biosci 12: 1496–1507

    Article  CAS  Google Scholar 

  10. Aono H et al. (1998) Extracellular human T cell leukemia virus type I tax protein stimulates the proliferation of human synovial cells. Arthritis Rheum 41: 1995–2003

    Article  CAS  Google Scholar 

  11. Kato T et al. (2004) HTLV-I env protein acts as a major antigen in patients with HTLV-I-associated arthropathy. Clin Rheumatol 23: 400–409

    Article  Google Scholar 

  12. Yakova M et al. (2005) Increased proviral load in HTLV-1-infected patients with rheumatoid arthritis or connective tissue disease. Retrovirology 2: 4

    Article  Google Scholar 

  13. Tachibana J et al. (1993) Lymphomatous polyarthritis in patients with peripheral T-cell lymphoma. Leuk Lymphoma 11: 459–467

    Article  CAS  Google Scholar 

  14. van Soesbergen RM et al. (1982) T cell leukemia presenting as chronic polyarthritis. Arthritis Rheum 25: 87–91

    Article  CAS  Google Scholar 

  15. Kitajima I et al. (1991) Detection of human T cell lymphotropic virus type I proviral DNA and its gene expression in synovial cells in chronic inflammatory arthropathy. J Clin Invest 88: 1315–1322

    Article  CAS  Google Scholar 

  16. Takahashi T et al. (2005) Treatment for HTLV-I associated arthropathy: a case study and synovial tissue culture analysis. Rheumatol Int 26: 74–79

    Article  Google Scholar 

  17. Yamamoto K et al. (1995) Oligoclonal proliferation of human T-cell leukemia virus type I infected lymphocytes in lesions of virus-induced arthropathy. Biochem Biophys Res Commun 208: 1040–1045

    Article  CAS  Google Scholar 

  18. Overbaugh J (2004) HTLV-I sweet-talks its way into cells. Nat Med 10: 20–21

    Article  CAS  Google Scholar 

  19. Fujinami RS et al. (2006) Molecular mimicry, bystander activation, or viral persistence: infections and autoimmune disease. Clin Microbiol Rev 19: 80–94

    Article  CAS  Google Scholar 

  20. García-Vallejo F et al. (2005) Autoimmunity and molecular mimicry in tropical spastic paraparesis/human T-lymphotropic virus-associated myelopathy. Braz J Med Biol Res 38: 241–250

    Article  Google Scholar 

  21. Reiff A (2005) A review of Campath in autoimmune disease: biologic therapy in the gray zone between immunosuppression and immunoablation. Hematology 10: 79–93

    Article  CAS  Google Scholar 

  22. Isaacs JD et al. (1996) Campath-1H in rheumatoid arthritis—an intravenous dose-ranging study. Br J Rheumatol 35: 231–240

    Article  CAS  Google Scholar 

  23. Isaacs JD et al. (1992) Humanized monoclonal antibody therapy for rheumatoid arthritis. Lancet 340: 748–752

    Article  CAS  Google Scholar 

  24. Matteson EL et al. (1995) Treatment of active refractory rheumatoid arthritis with humanized monoclonal antibody Camnpath-1H administered by daily subcutaneous injection. Arthritis Rheum 38: 1187–1193

    Article  CAS  Google Scholar 

  25. Weinblatt ME et al. (1995) Campath-1H, a humanized monoclonal antibody, in refractory rheumatoid arthritis. Arthritis Rheum 38: 1589–1594

    Article  CAS  Google Scholar 

Download references

Author information

Author notes

  1. P Chitkara is a Rheumatologist at the San Diego Arthritis Medical Clinic, CA, USA.

Authors and Affiliations

  1. G Dennis is Director of Clinical Development for Inflammatory Diseases at MedImmune, Inc., MD, USA,

    Gregory Dennis & Puja Chitkara

Authors
  1. Gregory Dennis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Puja Chitkara
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gregory Dennis.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dennis, G., Chitkara, P. A case of human T lymphotropic virus type I-associated synovial swelling. Nat Rev Rheumatol 3, 675–680 (2007). https://doi.org/10.1038/ncprheum0648

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncprheum0648

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing