[HTLV-I associated myelopathy (HAM) with adult T-cell leukemia (ATL)]

A 42-year-old female case of HTLV-I associated myelopathy (HAM) combined with adult T-cell leukemia (ATL) was reported. The patient noticed paresthesia in the soles at the age of 17, and gait disturbance and urinary retention at the age of 20. These symptoms progressed slowly. The patient showed indurations in both hypothenar regions and leukocytosis of 17,900/microliters in the peripheral blood at the age of 41. On admission to our hospital, she had spastic gait, muscle weakness of four extremities, increased deep tendon reflexes, pathologic reflexes, mild decreased of vibration sense and vesico-rectal disturbance. Anti-HTLV-I antibody (PA method) was increased to 1,024 fold in serum and 64 fold in spinal fluid. Thus, this patient was diagnosed as having HAM. In addition, leukocyte count in the peripheral blood was increased to 17,200/microliters including 33% atypical lymphocytes, and lymphocytes subset analysis showed 96.1% CD4+, 1.8% CD8+ and marked increase in CD4/CD8 ratio. Southern blot analysis of HTLV-I provirus DNA in the lymphocytes was of complete type with a monoclonal mode of integration. These findings indicated a diagnosis of ATL for this patient. HLA typing revealed A2, A11, Bw22, Bw46, Cw1, Cw3, being compatible with HAM type reported by Usuku et al. HAM and ATL were reported to be caused by an identical virus. However, there has been no case report of combination of the two diseases. Usuku et al proposed that the development of each disease was based on the differences in HLA haplotypes and HTLV-I-specific immune responsiveness.(ABSTRACT TRUNCATED AT 250 WORDS)