Acute Respiratory Failure Due to Mucous Plug in a Patient With Tropical Spastic Paraparesis

Tropical spastic paraparesis (TSP) or human T-lymphotropic virus type 1 (HTLV-1) myelopathy is a chronic inflammatory disease of the spinal cord caused by HTLV-1. It usually presents as a disease of the lower extremities, characterized by paralysis and sensory loss. HTLV-1 is common. However, only a small fraction of those infected actually experience clinical symptoms. Respiratory complications are rare; this case discusses an uncommon presentation of acute respiratory failure in a patient with TSP. A bedridden 73-year-old female with HTLV-1-associated TSP, presenting with progressive deterioration of motor and sensory functions in the lower limbs for 10 years, was admitted with sepsis due to recurrent urinary tract infection. On admission, she had hypotension with leukocytosis. She had initial stabilization but showed hypoxia and hypotension on day 5 with a chest X-ray showing total left lung collapse due to an obstructive mucous plug. She has been given hypertonic saline nebulizers and chest physiotherapy, following which there was a partial recovery; however, she then suffered a cardiac arrest that was followed by a tracheostomy for airway protection. In this case, the potential respiratory risk factors associated with TSP, such as failure to clear secretions properly, are underlined. Further research is needed with respect to respiratory muscle involvement in TSP patients and proactive airway management strategies. The tracheostomy intervention performed here only proves the need for addressing respiratory complications in this vulnerable population.