McArthur J C, Griffin J W, Cornblath D R, Griffin D E, Tesoriero T, Kuncl R, Gibbs C J, Farzadegan H, Johnson R T
Johns Hopkins Medical Institutions, Baltimore, MD.
Neurology. 1990 Jun;40(6):938-44. doi: 10.1212/wnl.40.6.938.
Two human retroviruses, HIV-1 and HTLV-I, have been associated with myelopathies in addition to other neurologic disorders. We report an American dually infected with HIV-1 and HTLV-I who developed steroid-responsive myeloneuropathy. This 28-year-old bisexual man developed interstitial pneumonitis and a transient midthoracic sensory level followed by the evolution of a slowly progressive spastic paraparesis and sensorimotor neuropathy. Serologic studies demonstrated coinfection with both HIV-1 and HTLV-I. Peripheral blood absolute CD4 count was persistently within the normal range. Cranial MRI was normal and spinal MRI showed T3-T10 atrophy. Serial CSF analyses demonstrated marked intrathecal synthesis of anti-HTLV-I IgG, lymphocytic pleocytosis, elevated protein and immunoglobulin G, and oligoclonal bands. HIV-1 was isolated from CSF but not from peripheral nerve. Lymphoproliferative studies confirmed spontaneous proliferation in both blood and CSF. Soluble interleukin 2 receptor and soluble CD8 were greatly elevated in blood and CSF when compared with patients with HIV-related vacuolar myelopathy and seronegative patients with other causes of myelopathy. Nerve biopsy showed epi- and endoneurial CD8+ lymphocytic infiltration without vasculitis; muscle biopsy showed features of acute and chronic denervation. A 6-week course of prednisone produced sustained improvement in leg strength and walking times. We speculate that the myeloneuropathy was caused by HTLV-I in the setting of coinfection with HIV-1.
两种人类逆转录病毒，即HIV-1和HTLV-I，除了与其他神经系统疾病有关外，还与脊髓病有关。我们报告了一名同时感染HIV-1和HTLV-I的美国患者，他患上了类固醇反应性脊髓神经病。这名28岁的双性恋男性出现了间质性肺炎和短暂的胸中段感觉平面，随后逐渐发展为缓慢进展的痉挛性截瘫和感觉运动神经病。血清学研究表明同时感染了HIV-1和HTLV-I。外周血绝对CD4计数持续在正常范围内。头颅MRI正常，脊髓MRI显示T3-T10萎缩。连续的脑脊液分析显示抗HTLV-I IgG有明显的鞘内合成、淋巴细胞增多、蛋白和免疫球蛋白G升高以及寡克隆带。从脑脊液中分离出了HIV-1，但未从周围神经中分离出。淋巴细胞增殖研究证实血液和脑脊液中均有自发增殖。与HIV相关空泡性脊髓病患者和其他脊髓病病因的血清阴性患者相比，血液和脑脊液中的可溶性白细胞介素2受体和可溶性CD8大大升高。神经活检显示神经外膜和神经内膜有CD8+淋巴细胞浸润但无血管炎；肌肉活检显示有急性和慢性失神经支配的特征。为期6周的泼尼松治疗使腿部力量和步行时间持续改善。我们推测，在同时感染HIV-1的情况下，脊髓神经病是由HTLV-I引起的。
