Chronic myelopathy associated with human T-lymphotropic virus type I (HTLV-I) has been described in several endemic areas in Brazil. In Salvador, 102 patients with myelopathy were screened for HTLV-I/II by ELISA and Western blot assays. We found 36 patients with HTLV-I/II associated myelopathy confirming the high prevalence of HAM in Salvador. The initial complaint of our patients were urinary urgency, back pain and progressive unsteadiness on walking. On examination all of them had a spastic paraparesis, variable degrees of lower motor neuron syndrome, deep and superficial sensitive syndrome. MRI analysis revealed lesions in the periventricular white matter in addition to atrophy of the thoracic spinal cord. Clinical and magnetic resonance findings reveal that the inflammatory lesions of HAM involve not only the spinal cord but also the brain and peripheral nervous system.
PIP: During November 1990 and June 1992 a total of 102 patients with myelopathy who attended four hospitals in the city of Salvador, Bahia, Brazil, were studied. The human T-cell lymphotropic virus types I and II (HTLV-I/II) was obtained by means of enzyme-linked immonosorbent assay (ELISA) and Western blot tests. There were 36 patients who had HTLV-I/II associated myelopathy (HAM) of whom 26 were women (72%). The age range was 8 to 82 years, and the average age of those with HTLV-I myelopathy was 45.8 years. Previous history of blood transfusion was established in 6 patients. Only 3 patients had a history of promiscuity, defined as more than 5 partners in a year. The most frequent clinical symptoms included progressive weakness in the lower extremities (29/36), followed by lumbar pain (18/36), and urinary urgency (15/36). The progression of myelopathy was slow and gradual in 25 cases and more rapid in 11 cases, reaching severe muscular force in about 2 years. Except for 2 patients all others reported asymmetry in the muscular force of the lower extremities. On examination all of them had a spastic paraparesis, variable degrees of lower motor neuron syndrome, and deep and superficial sensitive syndrome. Clinical and magnetic resonance findings revealed that the inflammatory lesions of HAM involved not only the spinal cord but also the brain and the peripheral nervous system. Magnetic resonance examination of the thoracic column of 19 patients demonstrated encephalitic disorder in 11 patients. The cerebrospinal fluid (LCR) indicated cellular augmentation in 24 patients with the range of cells from 1 to 40 per cubic millimeter and with the predomination of lymphocytes. Electrophoresis of proteins of LCR showed the increase of albumin in 8 patients and the increase of gamma globulin in 29 patients. HIV antibodies were detected in 2 patients.