Introduction

The human T-lymphotropic virus has been associated with human disease, affecting CD4⁺ T, CD8⁺ T, and B lymphocytes. It can cause T-cell leukemia/lymphoma and HTLV-associated myelopathy.

Case presentation

A 31-year-old woman was admitted after 2 months of cramps, paraparesis, and fecal/urinary incontinence. She was diagnosed with neurosyphilis according to the cerebrospinal fluid analysis. Despite treatment with crystalline penicillin there was no recovery, and anti-HTLV-1/2 tests were positive; therefore, the diagnosis of HTLV-associated myelopathy was made. The patient rejected glucocorticoid treatment; baclofen and carbamazepine were used to treat spasticity and cramps, respectively. The patient has not had progression.

Discussion

HTLV-associated myelopathy is generated by an exaggerated inflammatory response in the central nervous system with clonal expansion of CD4⁺ T and CD8⁺ T lymphocytes. There is not a specific and useful treatment; glucocorticoids can reduce inflammation, but do not improve clinical functional outcomes. There is a high prevalence of syphilis and human T-lymphotropic virus co-infection in tropical countries; however, myelopathy as the first clinical manifestation is unusual. The treatment of neurosyphilis could reduce the inflammation into the central nervous system and could decrease the progression of sequelae. This is the first case of myelopathy secondary to viral and treponemal co-infection confirmed in Colombia.

中文翻译：

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继发于人类 T 淋巴细胞病毒和梅毒螺旋体感染的脊髓病：病例报告。

介绍

人类嗜 T 淋巴细胞病毒与人类疾病有关，影响 CD4 ⁺ T、CD8 ⁺ T 和 B 淋巴细胞。它可导致 T 细胞白血病/淋巴瘤和 HTLV 相关脊髓病。

案例展示

一名 31 岁女性因痉挛、截瘫和大小便失禁 2 个月后入院。根据脑脊液分析，她被诊断为神经梅毒。尽管用结晶青霉素治疗，但仍未恢复，抗 HTLV-1/2 检测呈阳性；因此，诊断为HTLV相关性脊髓病。患者拒绝糖皮质激素治疗；巴氯芬和卡马西平分别用于治疗痉挛和痉挛。患者尚未出现进展。

讨论

HTLV 相关脊髓病是由中枢神经系统中过度的炎症反应以及 CD4 ⁺ T 和 CD8 ⁺ T 淋巴细胞的克隆性扩增引起的。没有具体有效的治疗方法；糖皮质激素可以减轻炎症，但不能改善临床功能结果。热带国家梅毒和人类嗜T淋巴细胞病毒双重感染的患病率很高；然而，以脊髓病为首发临床表现的情况并不常见。神经梅毒的治疗可以减少中枢神经系统的炎症，并可以减少后遗症的进展。这是哥伦比亚确认的第一例继发于病毒和密螺旋体混合感染的脊髓病病例。