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Título

HUMAN T-LYMPHOTROPIC VIRUS TYPE I MYELOPATHY: A CASE REPORT

Apresentação do caso único

The Human T-lymphotropic virus type 1 (HTLV-1) is endemic in some regions and is associated with a broad spectrum of symptoms, including neurological ones. Many pathogenic mechanisms in HTLV-1 chronic infection are mainly inflammatory, with CD8 and CD4 T-cell infiltration. Common neurological manifestations include slowly progressive spastic paraparesis and urinary sphincter control abnormalities. Diagnosis requires clinical manifestations and serological testing. Treatment is primarily corticotherapy, with better outcomes if on set early. However, diagnostic delays and limited studies on therapeutics hinder proper early treatment.

Discussão

A child female late preterm (36 weeks) with normal prenatal serologies, born via C-section with no complications, Apgar 9/9, and successfully breastfed. Her mother was diagnosed with HTLV in 2023 after blood donation and advised family testing. At 10-year-old this girl presented with lower limb pain, worsening with movement, beginning in the lumbar region and radiating to the leg, with neuropathic characteristics. She had chronic constipation requiring polyethylene glycol and long-term urinary incontinence without perceiving urinary loss. She Physical exam showed alertness, no cranial nerve abnormalities, normal tone, strength 5/5, normal reflexes, intact sensibility, no ataxia, but bilateral Babinsky sign. Serum PCR was positive for HTLV-1. Lumbar puncture showed no abnormalities. MRI showed mild spinal cord atrophy, likely secondary to HTLV-1. HTLV-1 myelopathy was the main hypothesis. The patient received IV methylprednisolone pulse therapy for five days and pregabalin for neuropathic pain. Outpatient reevaluation showed improvement in pain and urinary continence.

Comentários finais

Data on the onset of symptoms in children are scarce. Some studies even point to HTLV myelopathy as a pathology almost exclusive to adults. Studies in adults show a predominance of females with a ratio of 2:1 in relation to males. The mean age of patients at the onset of symptoms was 44.8 years. Diagnosing HTLV-1 myelopathy is challenging due to the broad symptom spectrum and low suspicion rate. Early treatment implies a better response, so physicians in endemic areas should consider this diagnosis for patients with chronic neurological complaints.

Referências

1. ARAUJO, Abelardo QC; SILVA, Marcus Tulius T. The HTLV-1 neurological complex. The Lancet Neurology, v. 5, n. 12, p. 1068-1076, 2006;

2. ARAUJO, Abelardo QC. Update on neurological manifestations of HTLV-1 infection. Current Infectious Disease Reports, v. 17, p. 1-7, 2015;

3. AZODI, Shila et al. Imaging spinal cord atrophy in progressive myelopathies: HTLV‐I‐associated neurological disease (HAM/TSP) and multiple sclerosis (MS). Annals of Neurology, v. 82, n. 5, p. 719-728, 2017;

4. CHAMPS, Ana Paula Silva; PASSOS, Valéria Maria de Azeredo; BARRETO, Sandhi Maria; VAZ, Luiz Sergio; RIBAS, João Gabriel Ramos. Mielopatia associada ao HTLV-1: análise clínico-epidemiológica em uma série de casos de 10 anos. Revista da Sociedade Brasileira de Medicina Tropical , [S. l.], v. 43(6), p. :668-672, 1 nov. 2010;

5. BITTENCOURT, Achiléa Lisboa; PRIMO, Janeusa; DE OLIVEIRA, , Maria de Fátima Paim. Manifestations of the human T-cell lymphotropic virus type I infection in childhood and adolescence. Jornal de Pediatria - Copyright © 2006 by Sociedade Brasileira de Pediatria doi:10.2223/JPED.1573, [s. l.], v. Vol. 82, ed. 6, 2006.

Palavras Chave

HTLV; myelopathy; incontinence