HUMAN T-CELL LYMPHOTROPIC VIRUS TYPE-1 MYOSITIS, PERIPHERAL NEUROPATHY, AND CEREBRAL WHITE-MATTER LESIONS IN THE ABSENCE OF SPASTIC PARAPARESIS

Background: The human T-cell lymphotropic virus type 1 (HTLV-1) is ass ociated with a chronic, progressive myelopathy termed tropical termed tropical spastic paraparesis or HTLV-1-associated myelopathy. An incre asing number of reports suggest that the spectrum of neurologic diseas es associated with HTLV-1 in quite diverse. Design: Case study. Settin g: A university teaching hospital (Ottawa General Hospital, Ottawa, On tario). Results: Serum creatine kinase levels were elevated (1091 U/L) . Antibodies for HTLV-1 were detected by Western blot analysis and con firmed, by polymerase chain reaction. Human immunodeficiency virus ant ibodies were not detected. Findings nf nerve conduction studies reveal ed 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 reson ance imaging scans of the brain showed chronic, extensive cerebral whi te matter involvement of more than 7 years' duration. Treatment with o ral steroids resulted in an approximate 40% decrease in serum creatine kinase levels within 1 month and a marked improvement in strength. Co nclusions: 4 broad spectrum of neurologic disorders is associated with HTLV-1, which may or may not include spastic paraparesis. Patients wi th myopathies and/or neuropathies of unknown origin who are from areas endemic for HTLV-1 should Le screened for this retrovirus, even in th e absence of spastic paraparesis.