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Updated: Feb 17 2019

Human T-cell Lymphotropic Virus (HTLV)

  • 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
      • human T-cell lymphotropic virus type 1 (HTLV-1)
        • icosahedral capid, segmented, enveloped, single-stranded, positive-sense RNA virus
        • clinical syndromes
          • adult T-cell leukemia/lymphoma
          • myelopathy/tropical spastic paraparesis
        • transmission
          • parenteral
          • sexual
          • vertical
    • Epidemiology
      • incidence
        • most common in Japan, Africa, South America, and Caribbean
      • risk factors
        • unprotected sexual intercourse
        • multiple sexual partners
        • increased age
        • female sex
    • Prognosis
      • most are asymptomatic
      • if symptomatic, the prognosis is poor
  • Presentation
    • Adult T-cell leukemia/lymphoma
      • hypercalcemia
      • hepatosplenomegaly
      • lymphadenopathy
      • skin lesions
        • variable morphologies
    • Myelopathy/tropical spastic paraparesis
      • backache
      • unstable gait
      • heaviness in the lower extremities
      • lower limb proximal muscle weakness
      • hyperreflexia
      • loss of control of bladder sphincter
  • Imaging
    • Brain magnetic resonance imaging (MRI)
      • myelopathy/tropical spastic paraparesis
        • periventricular and subcortical white matter changes
  • Studies
    • Labs
      • detection of anti-HTLV-1 antibodies via ELISA
      • detection of genomic RNA via RT-PCR
      • complete blood count > 5% abnormal lymphocytes
    • Peripheral blood smear
      • adult T-cell leukemia/lymphoma
        • "flower" cells
    • Making the diagnosis
      • based on clinical presentation and laboratory studies
  • Differential
    • Mycosis fungoides
      • distinguishing factor
        • generalized pruritus with well-demarcated erythematous plaques
  • Treatment
    • Medical
      • zidovudine + interferon-α
        • indication
          • first-line therapy
      • chemotherapy
        • indication
          • alternate first-line therapy
      • corticosteroids
        • indication
          • myelopathy/tropical spastic paraparesis
  • Complications
    • Opportunistic infections
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