Dados do Trabalho

Título

The variability of subacute onset HTLV-1 myelopathy

Resumo

HTLV-1 infects around 10-20 million people worldwide and despite its prevalence only a small fraction of the infected individuals ever manifest HTLV-1 related pathology. The most common neurological manifestation of HTLV-1 is the tropical spastic paraparesis, a chronic spastic paraparesis of insidious onset. The clinical manifestations include spasticity and/or hyperreflexia of lower extremities, urinary disturbances and lower extremity weakness. Radiologically, brain white matter lesions and mild atrophy of the spinal cord can be observed. Symptomatic treatment remains the mainstay of therapy. To report 3 cases of subacute onset myelopathy due to HTLV-1 infection. A retrospective study was performed on 3 patients with subacute onset myelopathy, positive serology for HTLV-1 and absence of other causes of acute myelopathy. The clinical history, physical examination, CSF, MRI, treatment and disclosure of the cases were all reviewed. All 3 patients were male, the age ranged between 29-41 years old. They were admitted to our hospital with a history of paraparesis, difficulty in walking and urinary disturbances and/or constipation over the last 2-5 months. The spinal MRI showed no significant alteration in one case, one presented as longitudinally extensive myelitis with swollen and high T2 signal in the cervical and thoracic spinal cord and the other with discrete degenerative alterations in cervical and lumbar spine, in addition to small foci of signal alterations in the high thoracic region. CSF examination revealed pleocytosis in all cases range between 15-28 leukocytes, with a lymphocytic-mononuclear pattern. All three patients had a positive serology for HTLV-1, and one was positive since childhood but had no symptoms until 2 months before admission. The two patients with abnormal MRI had negative AQP-4 IgG and one negative anti-MOG. Two patients received cycles of pulse therapy with IV mPSL with only insignificant or no improvement at all. One of these patients was still submitted to 5 plasmapheresis without any improvement. These two patients maintained urinary incontinence, erectile dysfunction and constipation, and, from these, one became totally plegic in inferior limbs. The patient which did not receive the mPSL treatment, had mild improvement of the symptoms. Despite an uncommon presentation, HTLV-1 can cause subacute paraparesia and thus, represents a differential diagnosis for neuromyelitis optica and other inflammatory myelitis.

Palavras Chave

HTLV-I; myelopathy; Tropical Spastic Paraparesis