Case Report: HTLV-1-Induced Adult T-Cell Leukemia and Tropical Spastic Paresis

• Published in: The American journal of tropical medicine and hygiene Vol. 105; no. 5; pp. 1298 - 1300
• Main Authors: Rosenthal, Reece, Kaplan, Julika, Ahmed, Mohammed, Mims, Martha, Weatherhead, Jill E
• Format: Journal Article
• Language: English
• Published: United States Institute of Tropical Medicine 20.09.2021; The American Society of Tropical Medicine and Hygiene
• Subjects: Antiviral Agents - therapeutic use; Case reports; Human T-lymphotropic virus 1 - pathogenicity; Humans; Iran; Leukemia; Leukemia-Lymphoma, Adult T-Cell - blood; Leukemia-Lymphoma, Adult T-Cell - drug therapy; Leukemia-Lymphoma, Adult T-Cell - physiopathology; Male; Middle Aged; Prednisone - therapeutic use; Spasticity; Travel; Treatment Outcome; United States; Iran; United States
• ISSN: 0002-9637; 1476-1645
• DOI: 10.4269/ajtmh.20-1656

Human T-lymphotropic virus type 1 (HTLV-1) is a retrovirus endemic in many areas around the world. HTLV-1 can induce the development of adult T-cell leukemia (ATL) or myelopathy/tropical spastic paraparesis (HAM/TSP). We report a patient who presented to our outpatient clinic with massive splenomegaly, weight loss, urinary retention, and lower extremity weakness for the previous 3 years. The patient was found to have positive HTLV-1 by ELISA and Western blot from peripheral blood. Evaluation of the spleen demonstrated T-cell large granular lymphocyte leukemia consistent with ATL. In addition to progressive lower extremity weakness, hyperreflexia and clonus, cerebral spinal fluid was positive for HTLV-1 by ELISA and had a reversed CD4-to-CD8 ratio consistent with HAM/TSP. These findings suggest HTLV-1 induced ATL and HAM/TSP presenting simultaneously in the same patient.