Myelopathy associated with human T-cell lymphotropic virus type 1 in Paraguay. A case report

Abstract

Myelopathy associated with HTLV-1 infection or tropical spastic paraparesis is a chronic degenerative disease of the central nervous system that mainly affects the spinal cord, it is a rare disease in our setting.
This case involves a 65-year-old woman, who presented with a 2-year history of progressive decrease in muscle strength of the lower limbs until it prevented her from walking, accompanied by urinary and fecal incontinence, and tingling in the lower limbs. Neurological physical examination: decreased muscle strength in the lower limbs (2/5), increased osteotendinous reflexes in the lower limbs, bilateral Babinky, hypoesthesia in the lateral aspect of the legs and the back and soles of the feet, patellar clonus, and no sensory level. Ancillary studies: normal cytochemical and cytological cerebrospinal. Fluid (slightly increased protein), absence of oligoclonal bands, negative HIV serology, negative autoimmune profile. Normal electromyography, normal tomography of the skull, thorax, and abdomen. Magnetic resonance imaging of the brain and spinal cord was normal at the beginning, when repeated after 8 months, inflammatory lesions in the brainand spinal cord were observed. PCR (polymerase chain reaction) in blood for HLTV-1 were positive.
The patient was treated with methylprednisolone pulses, followed by oral prednisone and azathioprine for 3 months without a favorable response and with corticosteroid side effects, so this treatment was discontinued. IV immunoglobulin 400mg kg/p/monthly for 3 months was started, with no response. Rituximab 500mg every 15 days was started 1 month ago, with the response to be evaluated in successive follow-up visits.
Conclusion: myelopathy associated with human T-cell lymphotropic virus type 1 (HTLV-1) or tropical spastic paraparesis (MAH/PET), should be considered in the differential diagnosis in a patient with myelopathy in Paraguay.