{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T13:37:16Z","timestamp":1776865036933,"version":"3.51.2"},"reference-count":9,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,9,19]]},"published-print":{"date-parts":[[2019,10]]},"abstract":"<jats:p>Human T-cell lymphotropic virus (HTLV) is a human oncoretrovirus known to cause adult T-cell leukaemia\/lymphoma (ATLL). Coinfection of human T-lymphotropic virus type 1 with Epstein-Barr virus (EBV) results in enhanced expression of the HTLV virus and leads to aggressive organ involvement from T-cell malignancy. It has also been observed that the prevalence of hepatitis B infection has been higher in patients with HTLV ATLL as compared with the general population in certain countries. We describe a case of a 34-year-old man who initially presented with leucocytosis, fatigue and conjunctival erythema. His radiological images revealed significant generalised adenopathy, and his flow cytometry analysis came back positive for CD4-positive T-cell lymphoma. He was subsequently diagnosed with HTLV-positive ATLL. Ultimately the patient was also diagnosed with acute hepatitis B and EBV. We describe a unique case of ATLL with coinfection with two other viruses, the association of which can be of potential prognostic value in guiding the treatment strategies for ATLL.<\/jats:p>","DOI":"10.1136\/bcr-2019-231086","type":"journal-article","created":{"date-parts":[[2019,10,23]],"date-time":"2019-10-23T15:35:58Z","timestamp":1571844958000},"page":"e231086","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["HTLV-positive adult T-cell leukaemia\/lymphoma with Epstein-Barr virus and hepatitis B coinfection"],"prefix":"10.1136","volume":"12","author":[{"given":"Ayesha","family":"Munir","sequence":"first","affiliation":[{"name":"Internal Medicine, Albany Medical Center Hospital, Albany, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mihir","family":"Raval","sequence":"additional","affiliation":[{"name":"Hematology\/Oncology, New York Oncology Hematology PC, Albany, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chunlai","family":"Zuo","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Albany Medical Center Hospital, Albany, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M Kristina","family":"Subik","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Albany Medical Center Hospital, Albany, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,10,23]]},"reference":[{"key":"2025082704092484000_12.10.e231086.1","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.ijid.2017.03.010","article-title":"Hepatitis B virus and human T-cell lymphotropic virus type 1 co-infection in the Northern Territory, Australia","volume":"58","author":"Marr","year":"2017","journal-title":"Int J Infect Dis"},{"key":"2025082704092484000_12.10.e231086.2","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1179\/102453308X316130","article-title":"Influence of Epstein-Barr virus infection in adult T-cell leukemia","volume":"13","author":"Ueda","year":"2008","journal-title":"Hematology"},{"key":"2025082704092484000_12.10.e231086.3","doi-asserted-by":"crossref","first-page":"1363","DOI":"10.1111\/hepr.12513","article-title":"Fatal reactivation of hepatitis B virus infection in a patient with adult T-cell leukemia-lymphoma receiving the anti-CC chemokine receptor 4 antibody mogamulizumab","volume":"45","author":"Ifuku","year":"2015","journal-title":"Hepatol Res"},{"key":"2025082704092484000_12.10.e231086.4","first-page":"843","article-title":"[A case of smoldering ATLL in high risk family and familial double infection of HTLV-1 and HBV]","volume":"101","author":"Sawada","year":"1991","journal-title":"Nihon Hifuka Gakkai Zasshi"},{"key":"2025082704092484000_12.10.e231086.5","first-page":"227","article-title":"And C viruses, human T-cell lymphotropic virus types I and II, and leukemias: a case-control study. The Italian leukemia Study Group","volume":"5","author":"Gentile","year":"1996","journal-title":"Cancer Epidemiology and Prevention Biomarkers"},{"key":"2025082704092484000_12.10.e231086.6","doi-asserted-by":"crossref","DOI":"10.3389\/fmicb.2012.00388","article-title":"Epidemiological aspects and world distribution of HTLV-1 infection","volume":"3","author":"Gessain","year":"2012","journal-title":"Front Microbiol"},{"key":"2025082704092484000_12.10.e231086.7","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1111\/j.1743-7563.2010.01320.x","article-title":"Adult T\u2010cell leukemia\/lymphoma in Taiwan: an analysis of 17 patients and review of the literature","volume":"6","author":"LEE","year":"2010","journal-title":"Asia\u2010Pacific Journal of Clinical Oncology"},{"key":"2025082704092484000_12.10.e231086.8","first-page":"1027","article-title":"[Clinical characteristics and prognosis in 12 patients with adult T cell leukemia\/lymphoma confirmed by HTLV-1 provirus gene detection]","volume":"37","author":"Wu","year":"2016","journal-title":"Zhonghua Xue Ye Xue Za Zhi"},{"key":"2025082704092484000_12.10.e231086.9","doi-asserted-by":"crossref","first-page":"170","DOI":"10.12659\/AJCR.901688","article-title":"Dual infection with hepatitis B and Epstein-Barr virus presenting with severe jaundice, coagulopathy, and hepatitis B virus chronicity outcome","volume":"18","author":"Rao","year":"2017","journal-title":"Am J Case Rep"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2019-231086","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T11:09:32Z","timestamp":1756292972000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2019-231086"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10]]},"references-count":9,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2019,10,23]]},"published-print":{"date-parts":[[2019,10]]}},"alternative-id":["10.1136\/bcr-2019-231086"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2019-231086","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,10]]}}}