Human T-cell lymphotropic virus type 1 (HTLV-1)-associated bronchioloalveolar disorder required differentiation from fibrotic chronic hypersensitivity pneumonitis

Figures

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  Fig. 1. (A) Chest radiograph taken 13 years after coronary artery bypass surgery shows cardiac enlargement and slight ground-glass opacities in the bilateral lower lung fields. (B) Chest radiograph was taken 2 months after previous chest radiograph (A) presents ground-glass opacities expanded to the bilateral upper lung fields, and profuse micronodules appear diffusely. The severity of cardiac enlargement was unchanged.

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  Fig. 2. Chest CT scan (A-D) shows diffusely distributed micronodules, which were relatively hyperattenuated, well defined, and uniform in size (1-3 mm in diameter). The micronodules are diversely distributed and some are located in the centrilobular areas; however, they mainly showed peribronchovascular and perilobular distribution (arrowheads). Interlobular septal thickening, areas of ground-glass opacity, and traction bronchiectasis/bronchiolectasis are predominantly observed in bilateral lower lobes (arrow). Air trapping is also observed, especially in the lower lobes, and appears like a mosaic attenuation pattern (resembling the 3-density pattern). Metal artifacts are seen in the sternum from coronary artery bypass graft surgery.

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  Fig. 3. Biopsy specimen obtained from the right lower lobe (S8) shows that micronodules are mainly located around the airways, but sometimes in the periphery of the secondary lobule. (A, HE stain; X20) These nodules consist of severe lymphoid infiltration without atypia. These lymphocytes are predominantly T-cells on immunohistochemistry (CD3-positive cells dominant and normal CD4/8 ratio was). Non-necrotizing granulomas (arrows) and Langhans giant cells (arrowheads) are also detected (B, HE stain; X100, C, HE stain; X200). Enlarged airspaces are lined by bronchiolar-type epithelium and surrounded by dense fibrosis. Mucin and inflammatory cells fill many of the restructured airspaces (D, HE stain; X20).