Department of Neurology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
Department of Neurology, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
BMJ Case Rep. 2021 Jun 7;14(6):e241366. doi: 10.1136/bcr-2020-241366.
Human T-lymphotropic virus type I (HTLV-I) is a retrovirus associated with adult T-cell lymphoma (ATL) and HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP). In addition to HAM/TSP and ATL, HTLV-I-associated encephalopathy and cerebellar involvement have been reported. We report a case of an 87-year-old Japanese woman presenting with progressive dysarthria and gait disturbance. Neurological examination showed word-finding difficulty, scanning speech, saccadic eye movements, ocular dysmetria, gaze-evoked nystagmus and bilateral dysmetria. There was no motor weakness or spasticity. HTLV-I antibody was detected in both her serum and cerebrospinal fluid. Cerebrospinal fluid neopterin (57 pg/mL) and IgG index (3.27) were significantly elevated. MRI showed cerebellar swelling. She was finally diagnosed with HTLV-I associated cerebellitis. Two courses of high-dose intravenous methylpredonine therapy attenuated cerebellar ataxia and cerebellar swelling. It suggests that cerebellitis can result from HTLV-I infection, regardless of the existence of ATL or HAM/TSP.
人类 T 淋巴细胞白血病病毒 I 型（HTLV-I）是一种逆转录病毒，与成人 T 细胞淋巴瘤（ATL）和 HTLV-I 相关的脊髓病/热带痉挛性截瘫（HAM/TSP）有关。除了 HAM/TSP 和 ATL 之外，还报道了与 HTLV-I 相关的脑病和小脑受累。我们报告了一例 87 岁日本女性，表现为进行性构音障碍和步态障碍。神经系统检查显示找词困难、扫视言语、眼球扫视运动、眼动失用、凝视诱发的眼球震颤和双侧运动失用。无运动无力或痉挛。她的血清和脑脊液中均检测到 HTLV-I 抗体。脑脊液中新蝶呤（57pg/mL）和 IgG 指数（3.27）显著升高。MRI 显示小脑肿胀。最终诊断为 HTLV-I 相关小脑炎。两疗程大剂量静脉甲基泼尼松龙治疗减轻了小脑性共济失调和小脑肿胀。这表明小脑炎可能由 HTLV-I 感染引起，无论是否存在 ATL 或 HAM/TSP。
