難治性潰瘍性口内炎が初発症状と考えられた急性型成人T細胞白血病の1例 A case of acute adult T-cell leukemia with severe ulcerative stomatitis considered as an early symptom
In March 1999, a 70-year-old man presented with ulceration of the oral mucosa and difficulty in swallowing accompanied by pain.<BR>Clinically, the oral ulcerations were characterized by a punched-out appearance, and the circumscribed lesions showed a trend toward bleeding with pain. The clinical diagnosis was herpetic gingivostomatitis.<BR>After admission, the patient received systemic antiviral agents (aciclovir), and corticosteroid ointment was applied to the oral lesions. Despite treatment, the oral ulcers remained unchanged, and the patient had a fever of unknown origin. Microscopic examination of a specimen of the oral ulcer revealed no definitive evidence of viral infection. On immunological examination, anti-ATLA was positive, and PPD reaction was negative. Subpopulation analysis of blood lymphocytes showed an increase in CD 4-positive cells and an increased CD 4/CD 8 ratio.<BR>Viral esophagitis was confirmed histopathologically by gastrointestinal examination. These findings suggested severe immune deficiency. A diagnosis of acute adult T-cell leukemia (ATL) was made at the Third Department of Internal Medicine of our university hospital. Chemotherapy for ATL was performed; however, the patient died of respiratory dysfunction caused by ATL cell infiltration of the lung in May 2000.
日本口腔外科学会雑誌 50(4), 251-254, 2004-04-20
Japanese Society of Oral and Maxillofacial Surgeons