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Pulmonary calcinosis in adult T‐cell leukaemia

A 56-year-old man presented with generalized lymphadenopathy and hepatosplenomegaly. He was seropositive for human T-cell lymphotropic virus type I (HTLV-I). The white cell count was 10Æ6 · 10/l with 16% abnormal lymphocytes having indented or lobulated nuclei. The serum calcium was 4Æ0 mmol/l. He was treated with intermittent chemotherapy and obtained complete remission. During follow-up, he was found unconscious with a serum calcium of 6Æ0 mmol/l and azotaemia, and was treated by haemodialysis. After recovery, the patient complained of exertional dyspnoea, although there were no significant abnormalities on chest radiographs. The PaO2 was 72Æ6 mmHg. Hypercalcaemia tended to recur despite chemotherapy. Death occurred 15 months after onset. A postmortem examination showed bronchopneumonia and calcium deposits in the lung parenchyma (left, von Kossa stain) and renal tubules (right, von Kossa stain). Hypercalcaemia is a frequent complication of adult T-cell leukaemia and is due to HTLV-I Tax-mediated production of parathyroid hormone-related protein from the leukaemic cells. Diffuse deposition of calcium along the alveolar septa is a rare cause of alveolar-capillary block. As conventional radiography is usually insensitive to pulmonary calcinosis, awareness of this condition is important for the appropriate management of respiratory failure in these cases.