Human T-cell lymphotropic virus type 1 (HTLV-1) can cause adult T-cell leukaemia/lymphoma (ATLL). Two patients originating from the Caribbean area with ATLL are described. The first patient developed respiratory insufficiency due to acute T-cell leukaemia. The diagnosis was suspected because of characteristics of abnormal lymphocytes in the blood smear. The second patient had lymphadenopathy and devel-oped severe hypercalcaemia. Both patients were typical cases of ATLL. The pathogenesis, clinical manifestations, pitfalls and treatment of this intriguing disease are discussed.
Infection with human T-cell lymphotropic virus type 1 (HTLV-1) may cause a distinctive malignancy, adult T-cell leukaemia/lymphoma (ATLL). The clinical features of ATLL can be divided into four different subtypes; acute, chronic, smouldering, and a lymphoma type. This HTLV-1-associated malignancy occurs mainly in Japan, the Caribbean area, Africa and parts of South America. This disease is rare in Europe. We describe two patients originating from the Caribbean with ATLL, one suffering from an acute T-cell leukaemia and the other from the lymphoma type. We also discuss the possible pitfalls of this disease, such as hypercalcaemia and infection with Strongyloides stercoralis.