Conditions affecting the spinal cord are diverse and sometimes present with atypical, vague symptoms that evolve overtime. Etiologies for these conditions include autoimmune, infectious, neoplastic, vascular, and hereditary‐degenerative diseases. We present a case of a rare type of infectious/autoimmnune myelopathy that also had some atypical features on presentation.
A 55‐year‐old Hispanic man with a history of DM2 and HTN presented with gradual, onset of unsteady gait, left lower‐extremity weakness and numbness and unilateral diplopia over 4 days. Initial MRI showed nonspecific changes in the white matter and right pontine region. MRA, carotid Doppler USG, and echocardiogram were normal. After 2 days he complained of lower back pain, urinary retention, numbness at the T5–T6 level and had bilateral extensor plantar response. MRI of the thoracic/lumbar spine showed multiple areas of increased intensity T6–T8 levels. His symptoms worsened and he was started on high‐dose corticosteroids. LP showed homogeneous lymphocytosis negative for malignancy. CSF serologies were non revealing. He only partially improved and plasmapheresis was started. He was discharged to rehab with minimal improvement. Five months later the patient returned with similar complaints. A repeat evaluation and similar treatment was given and again he was discharged to rehab. During this last hospitalization, HTLV‐1 antibodies on CSF were tested and resulted positive, a confirmatory viral DNA test establishing tropical spastic paraparesis.
HTLV‐1 causes a chronic progressive myelopathy known as tropical spastic paraparesis (TSP) or HTLV‐1‐associated myelopathy (HAM) It affects less than 2% of HTLV‐1 carriers. This retrovirus is endemic in the Caribbean, Japan, Africa, parts of Asia, Central America, and even in the southern United States. Primarily involving the thoracic cord, HAM/TSP is characterized by a slowly progressive spastic paraparesis and urinary disturbance. HAM/TSP has also been associated with other nervous system pathology that results in less frequent symptoms, suggesting cerebral, cerebellar, cranial nerve, and peripheral nerve involvement. Treatment is mainly supportive although corticosteroids have been reported to slow progression.
To cite this abstract:Lopez M. Unsteady Gait and Weakness — a Tropical Threat. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 371. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/unsteady-gait-and-weakness-a-tropical-threat/. Accessed March 30, 2020.