23 PRACTICA MEDICALÅ – VOL. IX, NR. 1(33), AN 2014 PRACTICA MEDICALÅ CAZURI CLINICE Adresă de corespondenţă: Daniela Vasile, MD, Department of Hematology, Emergency Universitary Hospital Bucharest, 169 Splaiul Independentei, 050098, „Carol Davila“ University of Medicine and Pharmacy, Bucharest e-mail: daniela.vasile@yahoo.com ABSTRACT We present the case of a patient diagnosed in SUUB Hematology with adult T-cell leukemia- lymphoma. The particularities of this case are the delay in diagnosis, the apparent onset of disease with severe eye and skin determination in the leukemic phase, and the particular lung involvement in the final stage of the disease. Keywords: ATLL, HTLV1 Human T lymphotropic virus related adult T-cell leukemia / lymphoma – presentation, prognosis and treatment. Case report Daniela VASILE 1,2 ; Ana-Maria VLADAREANU 1,2 ; Anamaria IOVA 1 ; Oana CAZACEANU 1 ; Madalina BEGU 1,2 ; Horia BUMBEA 1,2 1 Department of Hematology, Emergency Universitary Hospital, Bucharest 2 „Carol Davila“ University of Medicine and Pharmacy, Bucharest 4 P aent B.R., a 49 year old woman, contact- ed the Hematology Department of Bucha- rest University Emergency Hospital in No- vember 2007 for invesgaon of a lymphocytosis. When the paent presented herself, there were no subjecve complaints, no peripheral ade- nopathy, no organomegaly, mild leukocytosis with absolute lymphocytosis (Hb 13.3 g/dl, WBC 19.2 X 10 9 /L, S 35%, Lymph 47%, Mo18%, Plt 228 X 10 9 /L), kidney samples, LDH and serum calcium within normal limits. The imunopheno- type of the peripheral blood revealed atypical T lymphocytes CD4+ CD3- CD8-. The paent at- tended no further check-ups unl March 2011, by which me she had lost about 5 kilograms in one month and had extensive maculopapular, intense itching skin lesions and conjuncval hy- peremia. Ophthalmic and dermatological con- trols recommended anhistamine treatment, but following treatment the lesions spread. Physical examinaon revealed conjuncval hy- peremia, maculopapular and nodular lesions in the upper and lower limbs, bilateral axillary lymphadenopaes, with sizes reaching up to 2 cm, hepatomegaly (palpable about 2 cm below the costal line) and splenomegaly (with lower pole palpable 2 cm below costal line). Labora- tory invesgaon revealed leukocytosis (31 X 10 9 /L) with lymphocytosis (64%). Peripheral blood smears indicated polymorphic lympho- cytes, some with vacuoles. Bone marrow aspira- on showed 22% polymorphic lymphocytes, some large, with condensed chroman, irregu- lar nucleus, basophilic cytoplasm. The imuno- phenotypical examinaons of the peripheral blood and bone marrow confirmed once more the mature phenotype of the helper T-cell CD3+ CD4+ CD8- CD7- CD5-/+ CD2+ TCR alpha/beta+ CD25+ (see Figure 2). Laboratory analyses showed normal serum calcium 10.32 mg/dl (N