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Título

PAEDIATRIC-ONSET OF HTLV-1 ASSOCIATED TROPICAL SPASTIC PARAPARESIS, DUE TO VERTICAL TRANSMISSION - A CASE REPORT

RESUMO

Case presentation
M.L.F.O, 13 years old, female, previously diagnosed with neurogenic bladder, started at age 10 with an insidious condition of mechanical arthralgia in the right knee, associated with difficulty in walking and non-progressive or ascending asymmetrical lower limb paresis. Due to a family history of dermatopolymyositis in a first-degree relative, she was admitted to the hospital for investigation of inflammatory myopathies in a pediatric rheumatoid department.
On examination, hyperreflexia was identified in the lower limbs with an increased reflex area on the left, inexhaustible clonus on the left, grade IV strength distally in the left lower limb and paretic gait on the left, with no other clinical findings. Initial tests showed CPK 211, TGO 24, TGP 17, DLH 249, non-reactive Anti-Jo1. During investigation of infectious causes, the presence of antibodies to HTLV-1 was detected by Western Blot, with the presence of GD21, p19, p24 and rgp 46-I bands. Electroneuromyography of the lower limbs and resonance of the right thigh did not show any changes, however spinal resonance showed apparent thinning of the spinal cord of the dorsal segment.
The exclusion of acute infectious, metabolic, and demyelinating pathologies and the positivity of the serology for the HTLV-1 virus led to the diagnosis of tropical spastic paraparesis, pyramidal motor sequelae caused by HTLV infection, resulting from vertical transmission, whether via breastfeeding, transplacental or birth canal, considering maternal serology also positive for this virus.

Discussion
The human T cell lymphotropic virus type I (HTLV-1) was the first retrovirus isolated in humans, in a patient with cutaneous lymphoma. Currently, its prevalence in Brazil is 0.47%, and its manifestation as early-onset myelopathy has been described in 27 cases in the country. According to Bittencort et al, in a study carried out in Salvador, the infection is acquired mainly through breastfeeding, being the main form of vertical transmission, and then through sexual intercourse.

Final Comments
Spastic paraparesis is a severe and disabling myelopathy, with a chronic and progressive presentation, involving the pyramidal tract, with proximal leg weakness, low back pain and neurogenic bladder. When it begins in childhood, it is manifested by pyramidal signs followed by gait disturbances and sensory symptoms. The evolution is usually rapidly progressive, making early diagnosis essential.