• Sabiha Shahnaz, David Reich, Diana Arévalo-Valencia, Slavka Kucinska, Joanna Tulczynska, and Jean Fleischman.
• Department of Medicine, Mount Sinai Services, Queens Hospital Center, Jamaica, NY 11432, USA.
• J Gen Intern Med. 2007 Mar 1; 22 (3): 420-3.

BackgroundSince the initial description of human T cell lymphotropic virus (HTLV-1), clusters of this infection have been detected globally. Unlike HIV infection, most patients infected with HTLV-1 remain asymptomatic throughout their lifetime.Case ReportWe report the case of a 39-year-old Afro-Caribbean man with HTLV-1 infection presenting as hypercalcemia and granulomatous pneumocystis jiroveci pneumonia.ResultsInterestingly, the hypercalcemia presented with normal parathyroid hormone-related protein and low 1,25 dihydroxyvitamin D levels, and the presence of pneumocystis jiroveci in the granulomas was diagnosed with transbronchial biopsy taken during bronchoscopy. HTLV-1-associated adult T cell leukemia lymphoma (ATLL) was diagnosed in this patient by bone marrow and lymph node biopsy.ConclusionIncreased bone resorption, likely cytokine-mediated, is the most likely mechanism of hypercalcemia in this patient. This is believed to be the first description of this type of reaction to pneumocystis jiroveci in a HTLV-1-infected ATLL patient.

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