Indolent, waxing and waning cutaneous presentation of HTLV‐1‐associated adult T‐cell leukemia/lymphoma in an HIV‐1‐positive patient

We present an unusual case of human T‐cell leukemia‐lymphoma virus type 1 (HTLV‐1)‐associated adult T‐cell leukemia/lymphoma in an human immunodeficiency virus (HIV) patient who presented with non‐diffuse, papular, waxing and waning cutaneous eruptions. The patient is a 61‐year‐old Haitian male with history of HIV on highly active antiretroviral therapy (HAART) who presented with multiple painful pink papules on his distal fingers and back for more than a year with a waxing and waning course. Skin biopsy demonstrated a CD4+, CD25+, CD8− lymphocytic proliferation with a clonal T‐cell receptor gene rearrangement. Peripheral blood demonstrated lymphocytosis with a CD4:CD8 ratio greater than 20:1 and an identical T‐cell receptor (TCR) clone as that in the biopsy. HTLV‐1 antibodies and PCR testing for HTLV virus were positive. Retrospective review of CBCs during the past 8 years demonstrated chronic lymphocytosis with a sharp increase in absolute CD4 counts corresponding to the onset of rash. The patient lacked systemic symptoms after 6 months follow‐up.