Human T-lymphotropic virus type I-associated myelopathy in patients with the acquired immunodeficiency syndrome.
We describe two cases of serologically confirmed human T-lymphotropic virus type I (HTLV-I)-associated myelopathy involving North American men coinfected by the human immunodeficiency virus type 1. Our first patient suffered from a gradually progressive spastic paraparesis for 10 years prior to presenting with Kaposi's sarcoma, while our second patient developed subacutely progressive spastic paraparesis in the setting of full-blown acquired immunodeficiency syndrome. Autopsy examination of the spinal cords from these two cases revealed widespread axonal loss and demyelination principally involving the lateral columns of case no. 1 and the lateral and anterior columns of case no. 2. Vascular sclerosis and hyalinization were prominent in both cases, but in neither was there a conspicuous inflammatory component. In case no. 2, HTLV-I mRNA was not detected by in situ hybridization, but HTLV-I proviral DNA sequences were detected in this case by polymerase chain reaction. Neither case exhibited multinucleated cell (human immunodeficiency virus type 1) myelitis, vacuolar myelopathy, or evidence of HTLV-II infection by polymerase chain reaction assay.
Rosenblum
M K
MK
Department of Pathology (Neuropathology), Memorial Sloan Kettering Cancer Center, New York, NY 10021.
Brew
B J
BJ
Hahn
B
B
Shaw
G
G
Haase
A
A
Maroushek
S
S
Price
R W
RW
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D001344:Autopsy; D001483:Base Sequence; D015497:HIV-1 / Q000302:isolation & purification*; D015368:Human T-lymphotropic virus 1 / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D015493:Paraparesis, Tropical Spastic / Q000150:complications* / Q000473:pathology; D013118:Spinal Cord Diseases / Q000382:microbiology* / Q000473:pathology