Hamza Hamza, Silverstein Noah, McFarlane Samy I, Idris Hatim, Ouyang Daniel J
Internal Medicine, State University of New York Downstate Health Sciences University, Brooklyn, USA.
Cardiology, North Shore University Hospital, Long Island Jewish Medical Center, Long Island, USA.
Cureus. 2024 Nov 1;16(11):e72812. doi: 10.7759/cureus.72812. eCollection 2024 Nov.
Tropical spastic paraparesis (TSP) or human T-lymphotropic virus type 1 (HTLV-1) myelopathy is a chronic inflammatory disease of the spinal cord caused by HTLV-1. It usually presents as a disease of the lower extremities, characterized by paralysis and sensory loss. HTLV-1 is common. However, only a small fraction of those infected actually experience clinical symptoms. Respiratory complications are rare; this case discusses an uncommon presentation of acute respiratory failure in a patient with TSP. A bedridden 73-year-old female with HTLV-1-associated TSP, presenting with progressive deterioration of motor and sensory functions in the lower limbs for 10 years, was admitted with sepsis due to recurrent urinary tract infection. On admission, she had hypotension with leukocytosis. She had initial stabilization but showed hypoxia and hypotension on day 5 with a chest X-ray showing total left lung collapse due to an obstructive mucous plug. She has been given hypertonic saline nebulizers and chest physiotherapy, following which there was a partial recovery; however, she then suffered a cardiac arrest that was followed by a tracheostomy for airway protection. In this case, the potential respiratory risk factors associated with TSP, such as failure to clear secretions properly, are underlined. Further research is needed with respect to respiratory muscle involvement in TSP patients and proactive airway management strategies. The tracheostomy intervention performed here only proves the need for addressing respiratory complications in this vulnerable population.
热带痉挛性截瘫（TSP）或人类嗜T淋巴细胞病毒1型（HTLV-1）脊髓病是一种由HTLV-1引起的脊髓慢性炎症性疾病。它通常表现为下肢疾病，其特征为瘫痪和感觉丧失。HTLV-1很常见。然而，只有一小部分感染者会出现临床症状。呼吸并发症很少见；本文讨论了1例TSP患者罕见的急性呼吸衰竭表现。一名73岁的卧床女性，患有HTLV-1相关的TSP，下肢运动和感觉功能进行性恶化10年，因反复尿路感染伴脓毒症入院。入院时，她有低血压和白细胞增多。她最初病情稳定，但在第5天出现缺氧和低血压，胸部X线显示因阻塞性黏液栓导致左肺完全塌陷。给予她高渗盐水雾化器和胸部物理治疗后，病情有部分恢复；然而，随后她发生心脏骤停，之后进行气管切开以保护气道。在本病例中，强调了与TSP相关的潜在呼吸危险因素，如分泌物清除不当。需要进一步研究TSP患者的呼吸肌受累情况和积极的气道管理策略。此处进行的气管切开干预仅证明了在这一脆弱人群中应对呼吸并发症的必要性。
