Department of Ophthalmology & Visual Science, Graduate school of Medical and Dental Sciences, Institute of Science Tokyo, Tokyo, Japan.
Department of Hematology/Oncology, The Institute of Medical Science, Research Hospital, The University of Tokyo, Tokyo, Japan.
J Med Virol. 2024 Oct;96(10):e70000. doi: 10.1002/jmv.70000.
Human T-cell Lymphotropic Virus Type 1 (HTLV-1) is traditionally linked to severe conditions such as adult T-cell leukemia/lymphoma, HTLV-1-associated myelopathy, and HTLV-1 uveitis, with vertical transmission, particularly mother to child thorough breastfeeding, considered the primary route. Despite efforts to reduce vertical transmission through antenatal screening in Japan, horizontal transmission has contributed to the rising prevalence of HTLV-1 in metropolitan areas. This case reports the youngest documented instance of HTLV-1 uveitis resulting from horizontal transmission through sexual contact in an 18-year-old woman. The patient presented with blurred vision in her right eye, and a comprehensive ophthalmologic examination identified vitreous opacity and retinal vasculitis. Serological tests confirmed HTLV-1 infection, with a proviral load of 2.66 copies per 100 peripheral blood mononuclear cells, measured by real-time PCR. A differential diagnosis confirmed HTLV-1 uveitis. Further family and partner investigations confirmed horizontal transmission, most likely through sexual contact. Over 6 years of follow-up, the patient experienced multiple recurrences of HTLV-1 uveitis and developed HTLV-1-associated keratopathy. This case highlights the potential for rapid disease progression with relatively low proviral loads and short latency, emphasizing the need for updated public health strategies for sexually active young populations.
人类 T 细胞嗜淋巴细胞病毒 1 型（HTLV-1）传统上与严重疾病相关，如成人 T 细胞白血病/淋巴瘤、HTLV-1 相关性脊髓病和 HTLV-1 葡萄膜炎，垂直传播，特别是通过母乳喂养，被认为是主要途径。尽管日本在产前筛查方面做出了努力以降低垂直传播，但水平传播导致了 HTLV-1 在大都市地区的患病率上升。本病例报告了首例通过性接触导致的 18 岁女性 HTLV-1 葡萄膜炎的最小年龄记录。该患者因右眼视力模糊就诊，全面眼科检查发现玻璃体内混浊和视网膜血管炎。血清学检测证实了 HTLV-1 感染，实时 PCR 检测显示前病毒载量为每 100 个外周血单个核细胞 2.66 个拷贝。鉴别诊断证实为 HTLV-1 葡萄膜炎。进一步的家庭和伴侣调查证实了水平传播，最可能通过性接触。经过 6 年多的随访，该患者经历了多次 HTLV-1 葡萄膜炎复发，并发展为 HTLV-1 相关性角膜炎。本病例强调了在相对较低的前病毒载量和较短潜伏期下疾病快速进展的可能性，突出了更新针对性活跃年轻人群的公共卫生策略的必要性。
