HTLV-I-ASSOCIATED MYELOPATHY IN A SEYCHELLOIS IMMIGRANT

Objective: To describe the clinical and laboratory features of human T -lymphotropic virus type I (HTLV-I) associated myelopathy in an immigr ant from the Seychelles. Clinical features: A slowly progressive myelo pathy has been recently diagnosed in a 64-year-old woman who emigrated to Australia from the Seychelles in 1957. Sphincter disturbance and b ack pain were the first manifestations, followed by gait disturbance. Neurophysiological investigation supported the clinical diagnosis of a myelopathy and radiological investigations revealed no structural cau se. Serum antibodies to HTLV-I were detected by enzyme-linked particle agglutination and the presence of antibodies to individual HTLV-I gen e products in the serum was confirmed by western blot. The virus was d etected in a culture of the patient's peripheral blood mononuclear cel ls by antigen capture assay and by sequencing a polymerase chain react ion product amplified from the env gene. Intervention and outcome: The patient was advised of the nature and prognosis of her illness. Oral corticosteroids were tried without benefit. Conclusions: The prevalenc e of HTLV-I infection is low in Australia although it may be endemic i n some Aboriginal communities. Most infections are asymptomatic but th e chronic neurological disease associated with HTLV-I infection has no w been shown to exist in this country. HTLV-I infection should be cons idered in the aetiology of myelopathy without another obvious cause.