Novel Complications with HTLV‐1‐associated Myelopathy/Tropical Spastic Paraparesis: Interstitial Cystitis and Persistent Prostatitis

Abstract

Lower urinary symptoms associated with HTLV‐1‐associated myelopathy/tropical spastic paraparesis (HAM/TSF) are common, but have been regarded as ‘neurogenic’ due to spinal involvements. However, in some cases, these symptoms are persistent, progressive, and not directly correlated with the severity of other neurologic symptoms of the lower spinal cord. These findings prompted us to locate organic lesions in the lower urinary tract and to correlate them with HTLV‐1 infection. Among 35 HAM patients with lower urinary symptoms, we found 4 cases with the symptoms persistent and progressive: 3 with contracted bladder and another with persistent prostatitis. Histological or cytological examinations indicated local lymphocytic infiltrations in the lower urinary tract in all cases: 3 by the infiltration in the bladder and the other by a high concentration of lymphocytes in expressed prostatic secretions. Of 3 cases whose urinary samples were available, 2 showed significant increase in the concentration of urinary anti‐HTLV‐1 antibody of IgA class. The urinary IgA antibody of the third case was not elevated, but the sample had been obtained after resection of the affected bladder. None of the control cases showed significant anti‐HTLV‐1 IgA antibody in urine except for a case of gross hematuria due to chemotherapy directed against adult T‐cell leukemia. We suggest inclusion of these processes into the spectrum of complications for HAM/TSP. The elevated excretion of anti‐HTLV‐1 of IgA class in urine may be an indicator of these complications.

Natural course of voiding function in patients with human T-cell lymphotrophic virus type 1-associated myelopathy

“…Only a small proportion ( < 5%) of HTLV-I-infected individuals will develop HAM/TSP or other organ disorders [4][5][6][7][8][9][10][11], while more than 95% will remain asymptomatic for life [12]. The role of HTLV-I in these diseases remains unclear.…”

HTLV-associated myelopathy in a cohort of HTLV-I and HTLV-II-infected blood donors

“…27 The possible HTLV-I1 HAM case had subepithelial lymphocytic nodules in the bladder without evidence of neurogenic contractions. Nomata et al 33 suggested that infiltration of the bladder with HTLV-I infected lymphocytes may be responsible for bladder symptoms in at least a minority of HAM patients. This case would suggest that HTLV-I1 may cause a similar clinical syndrome.…”

Mother-to-Child HTLV-1 Transmission: Unmet Research Needs

“…Conversely, bladder and bowels symptoms such as frequency and constipation are common in both HAM and pregnancy whilst gait can be expected to worsen due to the physiological changes in pregnancy. Neurogenic bladder which is commonly observed in HAM/TSP (Araujo, 2015), could impact urinary infection rate (Nomata et al, 1992), which, in turn, can induce preterm birth (Dautt-Leyva et al, 2018).…”