Tanaka T, Takagi A, Kojima S, Goto J, Tanaka M
Rinsho Shinkeigaku. 1989 Jan;29(1):102-7.
The patient was a 49-year-old woman. Since her age of 42, she noticed a proximal weakness of both legs. She also experienced pedal paresthesia and urinary frequency. Physical examination disclosed a diffuse goiter and bilateral Babinski sign. Results of EMG and muscle pathology were compatible with the diagnosis of polymyositis. Treatment with prednisolone improved muscle weakness, urinary difficulties and struma. 7 years later, HTLV-I antibody happened to be strongly positive both in serum and CSF. Then most of her neurological problems were attributed to HAM. However, recent studies of re-biopsy muscle specimens disclosed scattered necrotic fibers, phagocytosis and endomysial or perivascular infiltration of inflammatory cells. These infiltrating cells were classed mostly as helper/inducer T cells. These observations suggested the coexistence of polymyositis in the present case as well. So far, the combination of HAM and polymyositis has not been reported. It seems important to decide if HTLV-I could induce chronic polymyositis as in the case of HIV infections.
患者为一名49岁女性。自42岁起，她注意到双腿近端无力。她还经历了足部感觉异常和尿频。体格检查发现弥漫性甲状腺肿和双侧巴宾斯基征。肌电图和肌肉病理学结果与多发性肌炎的诊断相符。泼尼松龙治疗改善了肌肉无力、排尿困难和甲状腺肿。7年后，血清和脑脊液中的HTLV-I抗体均碰巧呈强阳性。然后她的大多数神经问题被归因于HAM（人类嗜T淋巴细胞病毒I型相关脊髓病）。然而，最近对重新活检的肌肉标本的研究发现了散在的坏死纤维、吞噬作用以及肌内膜或血管周围炎症细胞浸润。这些浸润细胞大多归类为辅助/诱导性T细胞。这些观察结果也提示本例存在多发性肌炎。迄今为止，尚未有HAM与多发性肌炎合并存在的报道。确定HTLV-I是否能像HIV感染那样诱发慢性多发性肌炎似乎很重要。
