[Steroid responsive rapidly progressive HTLV-1-associated myelopathy with HTLV-1-associated bronchioloalveolar...

An 84-year-old woman presented with a two months history of progressive bilateral lower limb weakness and bladder bowel disfunction. Neurological examination revealed spastic paraplegia and anti HTLV-1 antibodies were positive in the serum and cerebrospinal fluid. Due to the rapid progression along with the elevation of neopterin and CXCL-10 in the cerebrospinal fluid, the diagnosis of rapidly progressive HTLV-1 associated myelopathy (HAM) was made. Chest X-ray and CT coincidentally revealed diffuse micronodular opacities, nodular in various sizes, and interlobular septal thickening. HTLV-1 associated bronchioalveolar disorder was the most likely diagnosis. Steroid therapy was effective against both spastic paraplegia and pulmonary lesions. Although the pulmonary lesions were identified incidentally in our case, screening for pulmonary lesions is important in patients with spastic paraplegia as it may lead to early diagnosis of HAM.