Pregnancy complicated by HTLV-I associated myelopathy: two cases

We report two cases of HTLV-I associated myelopathy (HAM), a neurological disorder caused by the Human T-lymphotropic virus type-I (HTLV-I). Case 1 is a 41-year-old, 4 gravida, 4 multipara woman who notice dysuria and degradation of the muscle forces of the lower extremities at 39 years of age. At 22 weeks into her pregnancy, we examined her and diagnosed HAM based on her anti-HTLV-I antibodies being positive and on clinical manifestations. Case 2 is a 33-year-old primigravida, who noticed dysuria, light claudication and a weakness of the lower extremities. At 12 weeks into her pregnancy, she came to us for an examination; we diagnosed HAM based on her anti-HTLV-I antibodies being positive and on neurological findings. In these two cases, the courses of the pregnancies gave no cause for specific concern. No abnormal findings that might have possibly been caused by myelopathy were recognized in the course of delivery and uterine contraction, which were normal, and both had a vaginal delivery. In these cases, the anti-HTLV-I antibody titers in the serum by immunofluorescence were 5120X and 2480X respectively, and the antibody titer in the cerebrospinal fluid of both was a high level of 640X. We recognized that some lymphocytes in the peripheral blood showed sharp clefts in the nucleus. According to HLA haplotype, case 1 was A3B35Cw4DR1/A26(10)Bw48Cw-DR4, and case 2 A24B54Cw1DR1/A26B60Cw8DR12.