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Case Report: HTLV-1–Induced Adult T-Cell Leukemia and Tropical Spastic Paresis

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  • 1 Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas;
  • | 2 Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas;
  • | 3 Department of Hematology/Oncology, Baylor College of Medicine, Houston, Texas;
  • | 4 National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas;
  • | 5 Department of Pediatrics, Section of Tropical Medicine, Baylor College of Medicine, Houston, Texas


Human T-lymphotropic virus type 1 (HTLV-1) is a retrovirus endemic in many areas around the world. HTLV-1 can induce the development of adult T-cell leukemia (ATL) or myelopathy/tropical spastic paraparesis (HAM/TSP). We report a patient who presented to our outpatient clinic with massive splenomegaly, weight loss, urinary retention, and lower extremity weakness for the previous 3 years. The patient was found to have positive HTLV-1 by ELISA and Western blot from peripheral blood. Evaluation of the spleen demonstrated T-cell large granular lymphocyte leukemia consistent with ATL. In addition to progressive lower extremity weakness, hyperreflexia and clonus, cerebral spinal fluid was positive for HTLV-1 by ELISA and had a reversed CD4-to-CD8 ratio consistent with HAM/TSP. These findings suggest HTLV-1 induced ATL and HAM/TSP presenting simultaneously in the same patient.

Author Notes

Address correspondence to Jill E. Weatherhead, Texas Children’s Hospital, 1102 Bates Avenue, Suite 550, Houston, TX 77030. E-mail: weatherh@bcm.edu

Authors’ addresses: Reece Rosenthal, Julika Kaplan, Martha Mims, and Jill E. Weatherhead, Baylor College of Medicine, Medicine, Houston, TX, E-mails: reece.rosenthal@bcm.edu, julika.kaplan@bcm.edu, mmims@bcm.edu, and weatherh@bcm.edu. Mohammed Ahmed, Baylor College of Medicine, Pathology and Immunology, Houston, TX, E-mail: mohammed.ahmed@bcm.edu.