Enlarged, multifocal upper limb neuropathy with HTLV-I associated myelopathy in a patient with chronic adult T-cell leukemia.
The authors herein describe a case of multifocal peripheral neuropathy with HTLV-I-associated myelopathy (HAM) in a patient with chronic adult T-cell leukemia (ATL). The clinical features included subacute progressive sensory-motor neuropathy in the bilateral upper limbs, and bilateral pyramidal tract involvement with bladder dysfunction. An MRI with (67)gadolinium enhancement revealed enlargement of the affected peripheral nerves. (8)FDG positron emission tomography (PET) disclosed increased uptake in the affected nerves, suggesting neurolymphomatosis or inflammation. Anti-HTLV-I antibody was positive in both the serum and CSF. The HTLV-I proviral load in the peripheral blood mononuclear cells was high. Chemotherapy for ATL resulted in marked improvement of motor functions in the upper limbs. This is the first case of multifocal upper limb neuropathy with HAM in a patient with chronic ATL.
Umehara
Fujio
F
Department of Neurology and Geriatrics, Graduate School of Kagoshima University, Sakuragaoka 8-35-1, Kagoshima, Japan. umehara@m2.kufm.kagoshima-u.ac.jp
Hagiwara
Takaaki
T
Yoshimura
Michiyoshi
M
Higashi
Keiko
K
Arimura
Kimiyoshi
K
D001772:Blood Cell Count; D003287:Contrast Media; D005260:Female; D019788:Fluorodeoxyglucose F18; D005682:Gadolinium; D006801:Humans; D015461:Leukemia, Prolymphocytic, T-Cell / Q000150:complications*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009431:Neural Conduction / Q000502:physiology; D009460:Neurologic Examination; D015493:Paraparesis, Tropical Spastic / Q000150:complications*; D010525:Peripheral Nerves / Q000473:pathology / Q000503:physiopathology; D010523:Peripheral Nervous System Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology*; D049268:Positron-Emission Tomography; D034941:Upper Extremity / Q000000981:diagnostic imaging / Q000294:innervation / Q000473:pathology*
D003287:Contrast Media; D019788:Fluorodeoxyglucose F18; D005682:Gadolinium