Myelopathy secondary to human T-lymphotropic virus and Treponema pallidum infection: case report

Abstract

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.

Clonal cutaneous and neurosyphilis: A pitfall in pseudolymphoma diagnosis

“…Other prior reports have suggested an interaction between T. pallidum and another lymphotrophic virus, human T‐lymphotropic virus (HTLV) 12,13 . In one case report, a 31‐year‐old woman presented with HTLV‐associated myelopathy and neurosyphilis 12 . More atypical presentations of syphilis may be due to coinfections with lymphotropic viruses.…”

“…This may represent local reactivation of EBV in response to the T. pallidum present in the skin or it may be related to immunosuppression from the patient's prior follicular lymphoma and treatment with chemotherapy. Other prior reports have suggested an interaction between T. pallidum and another lymphotrophic virus, human T‐lymphotropic virus (HTLV) 12,13 . In one case report, a 31‐year‐old woman presented with HTLV‐associated myelopathy and neurosyphilis 12 .…”

HIV-associated dementia presenting predominantly with clinical motor deficits: A case report

“…MRI of the spine was unremarkable, ruling out spinal injury secondary to trauma or mass effect. Extensive laboratory data was collected to evaluate for etiologies of myelopathy; myelopathy in the setting of immunosuppression can occur secondary to opportunistic infections such as VZV, EBV, HTLV1, syphilis, and rarely PML [2] , [3] , [4] , [5] . Additionally, myelopathy has rarely been documented in those following infection with SARS-CoV2, which our patient had in August of 2021, although viral product is not detected in the CSF in the majority of these cases [6] .…”