A Case of Adult T-Cell Leukemia Initiated with Central Nervous System Symptoms

We treated a 52-year-old Japanese woman with adult T-cell leukemia(ATL) initiated with central nervous system (CNS) symptoms.Her chief complaints were paraplegia and left facial palsy.CNS-ATL was diagnosed because of the following three features.1) Various sized lymphoid cells with marked nuclear convolutionwere numerous in her cerebrospinal fluid. 2) These cells werea monoclonal proliferation of T lymphocytes with OKT 4 marker.3) The patient's serum was positive for anti-ATL associatedantigen (ATLA). Although the neurological signs and symptomsimproved markedly after intrathecal administration of combinedchemotherapy (methotrexate, cytarabine and corti-costeroid),these ATL cells were highly resistant to radiation therapy.The abdominal mass which developed in the course of the diseasewas diagnosed as a tumor formed of ATL cells, and VEPA (vincristine,endoxan, prednisolone and adriamycin) was administered withmarked success.