Steroid-responsive myeloneuropathy in a man dually infected with HIV-1 and HTLV-I

Justin Charles McArthur, J. W. Griffin, David Cornblath, Diane Griffin, T. Tesoriero, R. Kuncl, C. J. Gibbs, Homayoon Farzadegan, Richard Johnson

Research output: Contribution to journalArticle

Abstract

Two human retroviruses, HIV-1 and HTLV-I, have been associated with myelopathies in addition to other neurologic disorders. We report an American dually infected with HIV-1 and HTLV-I who developed steroid-responsive myeloneuropathy. This 28-year-old bisexual man developed interstitial pneumonitis and a transient midthoracic sensory level followed by the evolution of a slowly progressive spastic paraparesis and sensorimotor neuropathy. Serologic studies demonstrated coinfection with both HIV-1 and HTLV-I. Peripheral blood absolute CD4 count was persistently within the normal range. Cranial MRI was normal and spinal MRI showed T3-T10 atrophy. Serial CSF analyses demonstrated marked intrathecal synthesis of anti-HTLV-I IgG, lymphocytic pleocytosis, elevated protein and immunoglobulin G, and oligoclonal bands. HIV-1 was isolated from CSF but not from peripheral nerve. Lymphoproliferative studies confirmed spontaneous proliferation in both blood and CSF. Soluble interleukin 2 receptor and soluble CD8 were greatly elevated in blood and CSF when compared with patients with HIV-related vacuolar myelopathy and seronegative patients with other causes of myelopathy. Nerve biopsy showed epi- and endoneurial CD8+ lymphocytic infiltration without vasculitis; muscle biopsy showed features of acute and chronic denervation. A 6-week course of prednisone produced sustained improvement in leg strength and walking times. We speculate that the myeloneuropathy was caused by HTLV-I in the setting of coinfection with HIV-1.

Original languageEnglish (US)
Pages (from-to)938-944
Number of pages7
JournalNeurology
Volume40
Issue number6
StatePublished - 1990

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Human T-lymphotropic virus 1
HIV-1
Steroids
Spinal Cord Diseases
Coinfection
Immunoglobulin G
Spastic Paraparesis
Oligoclonal Bands
Biopsy
Interleukin-2 Receptors
Interstitial Lung Diseases
Leukocytosis
Denervation
Retroviridae
CD4 Lymphocyte Count
Vasculitis
Prednisone
Nervous System Diseases
Peripheral Nerves
Walking

ASJC Scopus subject areas

  • Arts and Humanities (miscellaneous)
  • Clinical Neurology
  • Neuroscience(all)

Cite this

Steroid-responsive myeloneuropathy in a man dually infected with HIV-1 and HTLV-I. / McArthur, Justin Charles; Griffin, J. W.; Cornblath, David; Griffin, Diane; Tesoriero, T.; Kuncl, R.; Gibbs, C. J.; Farzadegan, Homayoon; Johnson, Richard.

In: Neurology, Vol. 40, No. 6, 1990, p. 938-944.

Research output: Contribution to journalArticle

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