Adult T cell leukemia with cytomegalovirus associated hemophagocytic syndrome

: A 59-year-old woman, diagnosed as adult T-cell leukemia (ATL), was admitted because of fever and disturbance of consciousness. Peripheral blood examination demonstrated leukopenia and anemia, and subsequently thrombocytopenia. Bone marrow aspiration showed the increase of mature histiocytes with hemophagocytosis and a diagnosis of hemophagocytic syndrome (HPS) was established. She died due to respiratory failure on the eighth hospital day. Autopsy histological examination revealed systemic cytomegalovirus (CMV) infection with CMV pneumonia, and also demonstrated the findings of HPS in bone marrow, lymph nodes, and spleen. This case was considered as virus associated hemophagocytic syndrome (VAHS) developed by CMV infection. CMV is one of the causative viruses of VAHS and the opportunistic infection. In the patient with ATL in the immunodeficiency state, VAHS accompanied with opportunistic infection might be one of the causes of pancytopenia.