Human T-cell Lymphotropic Virus (HTLV) Type 1 Associated Myelopathy/tropical Spastic Paraparesis (HAM/TSP): A Case Report

Case Diagnosis: Human T-cell lymphotropic virus (HTLV) type 1 associated myelopathy/Tropical Spastic Paraparesis (HAM/TSP)

Case Description or Program Description: A 21-year-old female from Guyana presented to the clinic with bilateral leg weakness (right greater than left), urge incontinence, and low back pain. She reported the weakness started gradually along with low back pain approximately 2.5 years ago. The patient denied any recent injury or trauma, family history of spasticity, weakness, or diabetes. She had a series of magnetic resonance imaging (MRI) studies performed in 2021 and 2022 in her home country, which indicated osteophytes in L4-5 and minimal disc bulging in the L4-L5 and L5-S1 discs. Her physical exam was positive for upper motor neuron symptoms, lower extremity hyperreflexia, spastic gait of her right leg, and positive Babinski sign bilaterally. We referred the patient for electrodiagnostic studies. Brain, cervical, thoracic, and lumbar spine MRI was negative. The results of the electrodiagnostic studies were unremarkable. The patient was started on baclofen for muscle weakness and neurogenic bladder. Blood work was ordered to rule out tropical spastic paraplegia versus multiple sclerosis. Lab work came positive for IgA and HTLV I antibodies. The patient continued to be on baclofen and was encouraged to participate in a clinical trial.

Setting: Neurology Clinic

Assessment/Results: Brain, cervical, thoracic, and lumbar spine MRI was negative. The results of the electrodiagnostic studies were unremarkable. Lab work came positive for IgA and HTLV I antibodies.

Discussion (relevance): HAM/TSP is a serious complication of HTLV-1 infection. Patients develop neurologic symptoms of weakness, muscle stiffness, or spasms. There is no established treatment. The patient was encouraged to participate in a clinical trial and explained the importance of doing so. Clinicians and scientists can learn more about HAM/TSP and related disorders by encouraging patients to participate in clinical trials.

Conclusions: As clinicians, it is imperative to keep a broad differential as many neurological conditions have similar presentations. HAM/TSP is a progressive disease. However, it is rarely fatal. Patients' mental status improves if steps are taken to prevent urinary tract infections and if they participate in physical and occupational therapy programs.