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Answer 4
  1. HTLV-1. This patient has adult T-cell lymphoma/ leukemia (ATLL), a T-cell neoplasm associated with infection by HTLV-1, a retrovirus endemic to Japan, the Caribbean basin (including Jamaica), Africa, and the southeastern United States.5 The virus is spread via sexual contact, breast feeding, and blood transfusion. Patients with the acute form of ATLL present with rapidly developing B symptoms (eg, night sweats, weight loss), with diffuse lymphadenopathy, lymphocytosis, and hypercalcemia often associated with acute renal insufficiency. The disease responds poorly to therapy and is almost universally fatal. HIV, Epstein-Barr virus, and cytomegalovirus can all present with diffuse lymphadenopathy, but lymphocytosis is less common and hypercalcemia is rarely seen. Dengue fever occurs in the Caribbean but causes bone pain, not diffuse lymphadenopathy.

    5. Jaffe ES, Blattner WA, Blayney DW, et al. The pathologic spectrum of adult T-cell leukemia/lymphoma in the United States. Human T-cell leukemia/lymphoma virus-associated lymphoid malignancies. Am J Surg Pathol 1984;8:263-75.

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