A patient with progressive myelopathy and antibodies to human T-cell leukemia virus type I and human immunodeficiency virus type 1 in serum and cerebrospinal fluid
D. M. Aboulafia, E. H. Saxton, H. Koga, A. Diagne and J. D. Rosenblatt
Department of Medicine, UCLA School of Medicine 90024-1678.
A 52-year-old human immunodeficiency virus type 1-seropositive bisexual
black man was evaluated at UCLA because of the recent onset of progressive
lower-extremity weakness. Initial neurologic examination showed that the
patient's distal weakness was greater than his proximal weakness, with
bilateral foot drop and electrophysiologic evidence of denervation in the
distal lower extremities. Magnetic resonance imaging of the brain and
spinal cord disclosed no abnormalities. Subsequent neurologic evaluation 8
months later showed a myelopathy, with progression of lower-extremity
weakness, spasticity, and flexor spasms, and urinary incontinence, as well
as the peripheral neuropathy noted previously. A second magnetic resonance
imaging scan of the brain showed patchy foci of increased signal intensity
in white matter and cortex, with mild generalized cerebral and cerebellar
atrophy and no lesions in the spinal cord. Specimens of the patient's serum
and cerebrospinal fluid contained antibodies to human immunodeficiency
virus type 1. Additionally, specimens of his serum and cerebrospinal fluid
were tested for antibody to human T-cell leukemia virus type I by Western
blotting and radioimmunoprecipitation, and found to be positive for human
T-cell leukemia virus type I gag, env, and tax antibodies. The primary
cause of severe myelopathy in this patient may be infection with human
T-cell leukemia virus type I rather than with human immunodeficiency virus
type 1. Treatment with prednisolone resulted in improvement of the
lower-extremity weakness, reduction in flexor spasms, and slower but
significant improvement in urinary symptoms. Patients who are infected with
human immunodeficiency virus type 1 and have unusual motor findings should
be tested for concomitant human T-cell leukemia virus type I infection.
