BMJ Case Reports 2012; doi:10.1136/bcr-2012-006574
  • Findings that shed new light on the possible pathogenesis of a disease or an adverse effect

Are increased Foxp3+ regulatory T cells responsible for immunosuppression during HTLV-1 infection? Case reports and review of the literature

  1. Martin Montes1,2,3
  1. 1Department of Immunology, Instituto de Medicina Tropical ‘Alexander von Humboldt’, Universidad Peruana Cayetano Heredia, Lima, Peru
  2. 2Houston Academy of Medicine-Texas Medical Center Library, Houston, Texas, USA
  3. 3Department of Medicine, Division of Infectious Diseases. University of Texas Medical Branch, Galveston, Texas, USA
  1. Correspondence to Dr Martin Montes, martinmd{at}


Research of human T lymphotropic virus type I (HTLV-1)-associated diseases is mostly focused on inflammatory and lymphoproliferative disorders. However, the immunosuppressive consequences of HTLV-1 infection are frequently ignored. In developing countries where exposure to parasitic and other tropical diseases is frequent, the burden of disease is significantly increased by opportunistic infections. Regulatory T cells (Tregs) are a CD4 T-cell subset capable of suppressing effector responses. During HTLV-1 infection, CD4+Foxp3+ cells are increased in HTLV-1-associated leukaemia/lymphoma (ATLL) as well as in non-leukaemic presentations. However, controversy exists regarding the actual regulatory function of these cells. In this report, we present two cases of HTLV-1 ATLL complicated by parasitic organisms and we provide a brief review of the literature regarding FoxP3+ regulatory T cells and their role as a possible mechanism for the immunosuppressive manifestations that take place during HTLV-1 infection.

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