Human T-cell lymphotropic virus type 1 myositis, peripheral neuropathy, and cerebral white matter lesions in the absence of spastic paraparesis
A. G. Douen, C. E. Pringle and A. Guberman
Division of Neurology, Ottawa General Hospital, University of Ottawa, Ontario.
BACKGROUND: The human T-cell lymphotropic virus type 1 (HTLV-1) is
associated with a chronic, progressive myelopathy termed tropical spastic
paraparesis or HTLV-1-associate myelopathy. An increasing number of reports
suggest that the spectrum of neurologic diseases associated with HTLV-1 is
quite diverse. DESIGN: Case study. SETTING: A university teaching hospital
(Ottawa General Hospital, Ottawa, Ontario). RESULTS: Serum creatine kinase
levels were elevated (1091 U/L). Antibodies for HTLV-1 were detected by
Western blot analysis and confirmed by polymerase chain reaction. Human
immunodeficiency virus antibodies were not detected. Findings of nerve
conduction studies revealed an axonal neuropathy, while results of needle
electromyography were consistent with mixed neuropathic and myopathic
changes. Findings of a muscle biopsy supported the presence of
polymyositis. Magnetic resonance imaging scans of the brain showed chronic,
extensive cerebral white matter involvement of more than 7 years' duration.
Treatment with oral steroids resulted in an approximate 40% decrease in
serum creatine kinase levels within 1 month and a marked improvement in
strength. CONCLUSIONS: A broad spectrum of neurologic disorders is
associated with HTLV-1, which may or may not include spastic paraparesis.
Patients with myopathies and/or neuropathies of unknown origin who are from
areas endemic for HTLV-1 should be screened for this retrovirus, even in
the absence of spastic paraparesis.
