Abstract
A case of 64-year-old female with HTLV-I associated myelopathy (HAM) is reported. She was admitted to our hospital on December 15, 1986, because of slowly progressive gait disturbance and pollakisuria that had begun 15 years before. She had prominent pyramidal tract involvement, manifesting spastic paraplegia, hyperreflexia of the extremities and pathologic reflex. On sensory examination, only vibratory sense was decreased. The white blood cell count was within normal range, however atypical lymphocytes were observed less than 1%. The cerebrospinal fluid (CSF) contained 3/3 mononuclear cells per microliter, with normal glucose and protein concentrations. These cells in blood and CSF were similar to adult T-cell leukemia/lymphoma (ATLL) cells. Both serum and CSF antibody to HTLV-I were positive by the enzyme-linked immunosorbent assay and Western blot analysis. A cranial CT scan and a myelography showed no abnormalities. Other possible causes of the myelopathy were excluded. The diagnosis of HAM proposed by Osame and colleagues was obtained.
Patients with HAM have been found mainly in ATLL-endemic area, but rarely in ATLL-non-endemic area.
