Snapshot A 55-year-old woman presents to the emergency room with a 5-month history of worsening back pain. She recently immigrated from Japan and has a history of sexually transmitted diseases, each successfully treated. She reports that she has had a backache for the past few months, as well as an increasingly unstable gait resulting in falls, heaviness in her lower extremities, and difficulty climbing stairs. On physical exam, there is symmetric proximal muscle weakness in her thighs and generalized hyperreflexia. Imaging of the spine is normal. Serologic testing is positive for a retrovirus. Introduction Classification login to view 9 more bullets Epidemiology login to view 7 more bullets Prognosis login to view 2 more bullets Presentation Adult T-cell leukemia/lymphoma login to view 5 more bullets Myelopathy/tropical spastic paraparesis login to view 6 more bullets Imaging Brain magnetic resonance imaging (MRI) login to view 2 more bullets Studies Labs login to view 3 more bullets Peripheral blood smear login to view 2 more bullets Making the diagnosis login to view 1 more bullet Differential Mycosis fungoides login to view 2 more bullets Treatment Medical login to view 9 more bullets Complications Opportunistic infections