Effective Treatment With Tocilizumab in a Rheumatoid Arthritis Patient Complicated With Human T-cell Leukemia Virus Type 1-associated Myelopathy: A Case Report

Intern Med. 2020 Apr 23. doi: 10.2169/internalmedicine.4455-20. Online ahead of print.

Abstract

A 61-year-old woman with human T-cell leukemia virus type 1 (HTLV-1)-associated myelopathy (HAM)/tropical spastic paraparesis (TSP) and interstitial pneumonia (IP) was admitted to our hospital. She complained of sicca symptoms, polyarthralgia, and swollen joints. She was diagnosed with rheumatoid arthritis (RA) and Sjogren's syndrome. Methotrexate and anti-tumor necrosis factor therapy were not utilized because of the inclusion of severe respiratory disorders among the complications and the neurological symptoms of HAM/TSP. Tocilizumab monotherapy improved the RA disease activity without exacerbating HAM/TSP. The present case suggests that tocilizumab might be a suitable treatment option in patients with RA and HAM/TSP.

Keywords: antirheumatic therapy; biologic; human T-cell leukemia virus type 1; myelopathy; rheumatoid arthritis; tocilizumab.