Retinal vasculitis in a mother and her son with human T-lymphotropic virus type 1 associated myelopathy.

Abstract

A 53-year-old woman had difficulty in walking, raised titres to human T-lymphotropic virus type 1 A 53-year-old woman complained of difficulty in walking. The disorder was slowly progressive and was followed by spastic paraparesis. Results of routine tests were negative or within the normal range. Raised titres to HTLV-1 in the serum (1:1024) and cerebrospinal fluid (1:32) were found. Myelography, computed tomogra- phy, and magnetic resonance imaging showed normal findings. The patient was treated with prednisolone, 100 mg/day; thereafter the drug was tapered to 15 mg/day.In July 1990 no retinal lesions were found. In August her right visual acuity had decreased to 20/30. Cells were noted in the right anterior chamber. Whitish yellow lesions were found in the right temporal fundus (Fig 1). In addition multiple whitish dots were noted round the retinal veins. Fluorescein angiography showed that the retinal venous lesions did not leak (Fig 2). Routine laboratory test results were negative or within normal range, including blood pressure; blood glucose level; serum titres to adenovirus, herpes simplex virus, cytomegalovirus, varicella zoster virus, immunodeficiency virus, and toxoplasma; angiotensin-converting enzyme level; IgG; IgM; C-reactive protein; Treponema pallidum haemagglutinin; antibody to DNA; antinuclear antibody; rheumatoid arthritis factor; tuberculin skin test; and chest x ray findings. No oral aphthae or genital ulcers were noted.In September 1990 systemic prednisolone, 100 mg/day, diminished the cells in the right anterior chamber but had no effect on the yellowish white lesions or the retinal vasculitis.

Manifestações oculares observadas em indivíduos infectados por HTLV-I no Rio de Janeiro

“…Various ocular manifestations have been related to HTLV-I. The most found have been uveitis and retinal vasculitis 14,20,21,[31][32][33][34][35][36][37][38] . Goto et al 38 correlated the incidence of HTLV-I associated uveitis with the incidence of environmental or hereditary factors.…”

“…Ocular manifestations in patients with TSP/HAM include retinal vasculitis, retinochoroidal degenerative alterations, uveitis, vitreous opacities and cotton-wool exudates. Such patients are immunocompetent and do not present opportunistic infectious disease 14,[19][20][21][22][23][24][25][26] . Other reported ocular manifestations in patients with TSP/HAM include nystagmus, diplopia, optic atrophy, retrobulbar neuropathy and Behçet's syndrome 9,[27][28][29] .…”

Human T-Cell Lymphotropic Virus Type 1 Infection and Ocular Manifestations in São Paulo, Brazil

“…It is known to cause adult T-cell leukemia/lymphoma (ATLL) 4 and HTLV-1-associated myelopathy or tropical spastic paraparesis (HAM-TSP). 5 Ocular manifestations that have been described in HTLV-1-infected individuals include opportunistic infection and tumor infiltration of the eye and orbit in patients with ATLL [6][7][8] ; retinal microvascular changes, intraocular inflammatory disturbances, retinochoroidal degeneration, and keratoconjunctivitis sicca (KCS) in patients with HAM-TSP 7,[9][10][11][12] ; and HTLV-1-associated uveitis (HU) in asymptomatic carriers. 7,9,[13][14][15][16] Seroepidemiological surveys of highrisk groups 17,18 and blood donors from different parts of Brazil 19,20 show relatively high HTLV-1 seroprevalence rates compared with nonendemic areas such as the United States.…”

Vasculitis related to viral and other microbial agents

“…Vascular complications of HTLV-1 infection also include the inflammation of the uveal tract with anterior uveitis and retinal vasculitis [158,159]. HTLV-1 infection is diagnosed by the presence of elevated serum or CNS antibody titers to HTLV-1 in an appropriate clinical setting.…”