A 57-year-old man from Khorasan Razavi presented with severe hypercalsemia and fever, with tempreture up to 40°C, over a 2-week period. He also had severe headache and generalized bone pain. He was admitted and treated for hypercalcemia. After two days hypercalcemia and fever were controlled and bone pain decreased mildly but his headache continued severely. At first day of admission he was not anemic but one week later he became anemic and thrombocytopenic with atytipical lymphocyte in peripheral blood smear. During patient assessment we found, hyperuricemia, elevated ESR,CRP and LDH. Skeletal radiographies showed severe lytic bone lesion, and brain CT scan was normal. Based on these data, bone marrow exam was done and serum anti HTLV1 was requested. After 3 days we noticed several depressions on the scalp and forehead of the patient because of severe bone resorption. Bone marrow exam showed a patchy lymphocyte infiltration, and serum anti HTLV1 antibody was positive. CD4 also was positive in flowcytomery. All this findings were compatible with Adult T cell Lymphoma Leukemia secondary to HTLV1 infection which is endemic in Khorasan Razavi, Iran. The patient was died before beginning of induction therapy.

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Corresponding author
Zahra Mozaheb, Hematology-Oncology Department, Imam-Reza Hospital, Mashhad University of Medical Science, Mashhad, Iran (mozahebz@muma.ac.ir)