Intern Med. 2025 Jul 31. doi: 10.2169/internalmedicine.5938-25. Online ahead of print.
ABSTRACT
A 78-year-old woman with AQP4 antibody-positive neuromyelitis optica spectrum disorder (NMOSD) developed acute-type adult T-cell leukemia (ATL) 1 month after initiating satralizumab, without prior HTLV-1 screening. She presented with respiratory symptoms and hematochezia after receiving three doses. Laboratory tests revealed abnormal lymphocytosis and HTLV-1 positivity, with monoclonal proliferation. Despite CHOP chemotherapy, the patient died within two weeks of treatment initiation. IL-6 inhibition may impair the host defense against HTLV-1 oncogenesis. This case highlights the potential risk of ATL following treatment with satralizumab, especially in HTLV-1 endemic areas, and the importance of HTLV-1 screening and clonality assessment before treatment in patients with NMOSD.
PMID:40738679 | DOI:10.2169/internalmedicine.5938-25
