Inflammatory myopathy on HTLV-I infection: case report

Abstract

We describe a 41 years old woman who 17 years ago presented hypotonia and proximal muscular weakness in the upper and lower limbs. On neurological examination, the biceps, triceps and Achilles reflexes were absent; the brachioradialis reflexes were decreased and the patellar reflexes were normal. There was bilateral Babinski sign. The remainder of the neurological examination was unremarkable. In the investigation a myopathic pattern was found in the electromyography. The nerve-conduction study was normal; a ELISA method for HTLV-I antibodies was positive in the blood and in the cerebral spinal fluid. The muscle biopsy showed inflammatory myopathy, compatible with polymyositis. This paper focuses the polymyositis in the beginning of an HTLV-I infection case.KEY WORDS: HTLV-I, polymyositis, inflammatory myopathy.Miopatia inflamatória em infecção por HTLV-I: relato de caso RESUMO Descrevemos o caso de uma paciente que há 17 anos iniciou sua doença com hipotonia e diminuição da força muscular proximal nos membros superiores e inferiores. No exame neurológico apresentava arreflexia bicipital e tricipital, hiporreflexia estilorradial e reflexo patelar normal; sinal de Babinski bilateral. O restante do exame neurológico era normal. Na eletromiografia de agulha foi encontrado padrão miopático. O exame de condução nervosa estava normal. A pesquisa pelo método ELISA de anticorpos anti-HTLV-I foi positiva no sangue e no líquido cefalorraquidiano. A biópsia muscular mostrou miopatia inflamatória, compatível com polimiosite. O presente artigo enfoca a polimiosite na abertura do quadro clínico de uma infecção pelo HTLV-I. PALAVRAS-CHAVE: HTLV-I, polimiosite, miopatia inflamatória. Several syndromes have been associated to the HTLV-I. In neurology, the most frequent picture is the called HTLV-I associated myelopathy / tropical spastic paraparesis. Associated to this, more recently has been described the HTLV-I polymyositis 1 , and there are also a few cases of polymyositis alone. This paper reports a case of a patient who started with polymyositis and later developed a myelopathy with HTLV-I antibody positive. CASEA 41 years old white woman presented, since 1983, proximal muscle weakness of her left lower limb, and 6 months later also of the right side, with progressive worsening. After 5 years she presented proximal muscle weakness of both upper limbs. There were no sensitive disturbances or urinary incontinence. She also presented moderate myalgia and had several types of treatment without satisfactory result. She was treated with prednisone in the last 3 year and at time of evaluation was taking 5mg/day. She had a past history of hepatitis when was 19 years-old, urinary infection, apendicectomy and had received a blood transfusion.The neurological examination showed mental and cranial nerves examination with no involvement. There was not muscle atrophy. There was hipotonia in the four limbs. Weakness was presented in the four limbs, and was more prominent in the proximal groups (3/5) than in the distal ones (4/5)....

Immunopathogenesis and neurological manifestations associated to HTLV-1 infection

“…Two types of HTLV-1 associated myopathy have been described: inclusion body myositis 99 and polymyositis [100][101][102] . Generally those patients do not present with HAM/TSP and response to treatment is poor 99,100 .…”