title: Pathological and virological assessment of acute HTLV-I-associated myelopathy complicated with encephalopathy and systemic inflammation.
abstract: HTLV-I-associated myelopathy, also known as tropical spastic paraparesis (HAM/TSP), is a chronic inflammatory disease of the spinal cord. Acute cases are uncommon. We report the case of a 41-year-old woman with acute HAM/TSP complicated with encephalitis, an intense inflammatory reaction of the nervous system and lymphocytic infiltration of skeletal muscles, liver, salivary, adrenal and pituitary glands. The immunohistochemical studies of the lymphocytes surrounding blood vessels showed both B- and T-lymphocytes, in similar proportion, with both CD4- and CD8-positive cells. In addition, many perivascular and scattered macrophages were observed. Adult T-cell leukemia/lymphoma (ATL) was ruled out. The marrow aspirate was normal. Serial cerebrospinal fluid (CSF) analysis showed presence of HTLV-I antibodies, but without intrathecal synthesis of specific antibodies. Determination of HTLV-I viral loads demonstrated increased levels in the CSF relative to the peripheral blood and may be associated with widespread inflammation. The pathological and immunological findings may help understand the role of immune-reactive cells in the pathogenesis of HTLV-I-associated myelopathy.
authors.affiliation: Departments of Medicine and Pathology, Hospital Universitário Clementino Fraga Filho-HUCFF/UFRJ, Federal University of Rio de Janeiro, Av. Brigadeiro Trompowsky s/n, Brazil. msohler@netyet.com.br
authors.forename: Marzia
authors.initials: M
authors.lastname: Puccioni-Sohler
authors.forename: Leila
authors.initials: L
authors.lastname: Chimelli
authors.forename: Monica
authors.initials: M
authors.lastname: Merçon
authors.forename: Reizer R
authors.initials: RR
authors.lastname: Gonçalves
authors.forename: Glicinia
authors.initials: G
authors.lastname: Pimenta
authors.forename: Celso
authors.initials: C
authors.lastname: Bianco
authors.forename: Maria
authors.initials: M
authors.lastname: Rios
authors.forename: Steven
authors.initials: S
authors.lastname: Jacobson
mesh_terms: D000208:Acute Disease; D000328:Adult; D018792:Encephalitis, Viral / Q000150:complications / Q000473:pathology / Q000821:virology*; D004679:Encephalomyelitis / Q000150:complications / Q000473:pathology / Q000821:virology; D005260:Female; D015481:HTLV-I Antibodies / Q000096:biosynthesis / Q000134:cerebrospinal fluid; D015486:HTLV-I Antigens / Q000276:immunology; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000473:pathology / Q000821:virology; D015493:Paraparesis, Tropical Spastic / Q000134:cerebrospinal fluid / Q000150:complications / Q000821:virology*; D013116:Spinal Cord / Q000473:pathology / Q000821:virology
chemical_list: D015481:HTLV-I Antibodies; D015486:HTLV-I Antigens