Human T-Lymphotropic Virus 1 Adult T-Cell Lymphoma With Giardia and Strongyloides Parasitism
Bibliographic record
Abstract
A 40-year-old man originally from Togo, West Africa, developed a 2-month history of abdominal cramps, diarrhea, and weight loss, 4 years after immigrating to Canada. The patient was seropositive for human T-lymphotropic virus 1 (HTLV-1). No human immunodeficiency virus 1 or human immunodeficiency virus 2 antibodies were detected. The patient's complete blood count values were within laboratory reference intervals, and there specifically was no evidence of adult T-cell leukemia. Upper endoscopy revealed only esophageal candidiasis, which was confirmed histologically. Duodenal biopsies contained clusters of lymphocytes with large pleomorphic nuclei that infiltrated mucosa, including glandular epithelium, and submucosa (Figure, large arrow). These lymphocytes stained with antibodies directed against CD45RO and showed no immunoreactivity for CD20. Adult T-cell lymphoma was diagnosed and was also found involving the stomach. In addition to the diffuse neoplastic process, Giardia lamblia (small arrow) and Strongyloides stercoralis parasites were identified in duodenal biopsies. Occasional cytomegalovirus inclusions within gastric glandular epithelium were also present. Stool examination for ova and parasites revealed S stercoralis rhabditiform larvae, eggs, and parasitic females. Giardia lamblia cysts and trophozoites were also identified. No filariform Strongyloides larvae were present.Human T-lymphotropic virus 1 is an oncogenic retrovirus with a global distribution that is endemic to Southeast Asia, southwestern Japan, the Caribbean, the southeastern United States, and West Africa.1,2 Environmental cofactors, such as Strongyloides parasitism, have been suggested as possible contributing mechanisms to HTLV-1–associated leukemogenesis.3 It is controversial whether HTLV-1 carriers are at increased risk for Strongyloides infection.1 Human T-lymphotropic virus 1–infected patients with adult T-cell leukemia/lymphoma, however, are immunocompromised and specifically have defects of cell-mediated immunity.2 These patients are at increased risk for multiple opportunistic infections, including cytomegalovirus, herpes zoster, disseminated herpes simplex, Pneumocystis carinii, Cryptococcus, Candida, and enteric parasites, such as Strongyloides.2,4 Immunocompromised hosts with Strongyloides infections may develop autoinfection and disseminated strongyloidiasis as a result of direct transformation of rhabditiform larvae to filariform larvae within the gastrointestinal tract.1 Hosts infected with Strongyloides, like our patient, may have long periods of asymptomatic disease and may only become symptomatic with waning immunocompetence and heavy worm burdens. Persistent Strongyloides infections lasting decades have been reported as a result of continued autoinfection.1 In summary, this case illustrates that patients with HTLV-1–associated adult T-cell lymphoma/leukemia may develop multiple, clinically significant, opportunistic infections secondary to their immunocompromised state.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.004 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".