ABSTRACT
Here a young patient (< 21 years of age) with a history of infective dermatitis is described. The patient was diagnosed with myelopathy associated with HTLV-1/tropical spastic paraparesis and treated with interferon beta-1a. The disease was clinically established as HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), and laboratory tests confirmed the presence of antibodies to HTLV-1 in the cerebrospinal fluid (CSF). Mumps, cytomegalovirus, Epstein-Barr virus, schistosomiasis, herpes virus 1 and 2, rubella, measles, varicella-zoster toxoplasmosis, hepatitis, HIV, and syphilis were excluded by serology. The patient was diagnosed with neurogenic bladder and presented with nocturia, urinary urgency, paresthesia of the lower left limb, a marked reduction of muscle strength in the lower limbs, and a slight reduction in upper limb strength. During the fourth week of treatment with interferon beta-1a, urinary urgency and paresthesia disappeared and clinical motor skills improved.
Descreve-se caso de mielopatia associada ao HTLV-1/paraparesia espástica tropical tratada com interferon beta-1a em paciente jovem de 21 anos e com história de dermatite infecciosa na infância. Foi estabelecida clinicamente paraparesia espástica tropical (HAM/TSP), confirmada laboratorialmente pela presença de anticorpos para HTLV-1 no LCR e excluídas caxumba, citomegalovirus, Epstein-Barr, esquistossomose, herpes virus 1 e 2, rubéola, sarampo, toxoplasmose varicela-zoster, hepatite, HIV e sífilis por sorologias. Foi diagnosticada bexiga neurogênica, com quadro clínico de nictúria, urgência urinária, parestesia no membro inferior esquerdo e discreta redução de força muscular nos membros superiores, mais acentuada nos membros inferiores. Na 4a semana de tratamento com interferon beta-1a houve desaparecimento da urgência urinária e da parestesia e melhora da clínica motora.
Subject(s)
Female , Humans , Young Adult , Adjuvants, Immunologic/therapeutic use , Interferon-beta/therapeutic use , Paraparesis, Tropical Spastic/drug therapy , Treatment OutcomeABSTRACT
Se presenta el caso clínico de una paciente con diagnóstico inicial de hipotiroidismo, cuadro que ameritó internación, compensado adecuadamente con levotiroxina. A pesar de existir buena respuesta al tratamiento instaurado, persiste la presencia de sintomatología de compromiso neurológico por lo que se solicita evaluación por dicha especialidad; se encuentran datos sugestivos de un cuadro de paraparesia espástica tropical, enfermedad producida por el HTVLI. El diagnóstico es confirmado mediante examenes de laboratorio. Es tratada con pentoxifilina y vitamina C con respuesta clínica inicial buena, pero posteriormente presenta exacerbación de las manifestaciones neurológicas, como sucede habitualmente en esta patología. nuestro país se encuentra en una regíon endemica de la infección mencionada, y sin embargo el diagnóstico es mas bien esporádico. Se discute en este artículo la epidemiología, las dificultades diagnósticas que planteo este caso en particular y las posibilidades terapéuticas de esta enfermedad neurológica.
We present the case of a female patient who initially was diagnosed with hypothyroidism, and adequately compensated with levotiroxin . In spite of the otherwise successfultreatment, neurological symptoms persisted. The neurological examination showed datasuggestive of tropical spastic paraparesis,a disease caused by HTVL-1.The diagnosis was confirmed by laboratory tests. The patient was treated with pentoxifiline and vitamin C, initially with a good clinical response. Later on, however, exacerbation of the neurological symptoms resulted, as usually happens in this disease. In our country, tropical spastic paraparesis is endemic but only sporadically diagnosed. We review the most relevant aspects of epidemiology, the diagnostic difficulty in this case, and the therapeutic options for this neurological disease.
Subject(s)
Humans , Female , Adult , Free Radical Scavengers/therapeutic use , HTLV-I Infections/therapy , Paraparesis, Tropical Spastic/drug therapy , Paraparesis, Spastic/diagnosis , Pentoxifylline/therapeutic use , Ascorbic Acid/therapeutic use , Hypothyroidism/diagnosis , HTLV-I Infections/diagnosisABSTRACT
HTLV-1 infection is endemic in the Caribbean and several publications have reported the clinical disease entities seen in this population of patients. This case report is an account of a patient admitted to Kingstown General Hospital, St Vincent and the Grenadines, who had severe infective dermatitis, tropical spastic paraparesis (TSP) and Non-Hodgkin's Lymphoma (NHL). As far as we are aware, all three diseases have not been described in a single patient
Subject(s)
Humans , Female , Adult , HTLV-I Infections/diagnosis , Cyclophosphamide/therapeutic use , Dermatitis, Seborrheic/diagnosis , Dermatitis, Seborrheic/drug therapy , Dermatitis, Seborrheic/pathology , Diagnosis, Differential , Doxorubicin/therapeutic use , HTLV-I Infections/drug therapy , HTLV-I Infections/pathology , Lymphoma, Non-Hodgkin/diagnosis , Lymphoma, Non-Hodgkin/drug therapy , Lymphoma, Non-Hodgkin/pathology , Paraparesis, Tropical Spastic/diagnosis , Paraparesis, Tropical Spastic/drug therapy , Paraparesis, Tropical Spastic/pathology , Prednisone/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Vincristine/therapeutic useABSTRACT
El virus HTLV-I se asocia a varias patologías siendo las más relevantes la paraparesia espástica y la leucemia/linfoma de células T del adulto. No tiene tratamiento específico y se han intentado varios esquemas terapéuticos para su manejo. Se revisa la literatura presentando los trabajos más actualizados en relación a la terapia.
Subject(s)
Humans , Lymphoma, T-Cell/epidemiology , Lymphoma, T-Cell/etiology , Lymphoma, T-Cell/drug therapy , Paraparesis, Tropical Spastic/epidemiology , Paraparesis, Tropical Spastic/etiology , Paraparesis, Tropical Spastic/drug therapy , Paraparesis, Tropical Spastic/virology , Human T-lymphotropic virus 1/pathogenicity , Leukemia-Lymphoma, Adult T-CellABSTRACT
Descrevemos dois casos clínicos de paraparesia espástica tropical/mielopatia associada ao HTLV-I, obedecendo os critérios da OMS-1989. Estes são os primeiros casos diagnosticados em Cuiabá. Em um dos casos houve resposta clínica ao uso de prednisona.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Paraparesis, Tropical Spastic/diagnosis , Brazil , Glucocorticoids/therapeutic use , Paraparesis, Tropical Spastic/drug therapy , Prednisone/therapeutic useABSTRACT
Descrevemos dois casos clínicos de paraparesia espástica tropical / mielopatia associada ao HTLV-I (PET/MAH), segundo os critérios da OMS-1989. Estes sao os primeiros casos diagnosticados em Florianópolis (SC-Brasil). Em um dos casos houve resposta clínica ao uso de metilprednisolona.
Subject(s)
Middle Aged , Female , Humans , Methylprednisolone/therapeutic use , Paraparesis, Tropical Spastic/diagnosis , Brazil , Paraparesis, Tropical Spastic/drug therapyABSTRACT
Foram estudados 6 pacientes portadores de Paraparesia Espástica Familiar, 2 mulheres e 4 homens, com idades variando de 4 a 45 anos, mediana 41,5 anos em relaçäo ao tratamento da espasticidade de membros inferiores, através de bloqueios com Toxina Botulínica e Fenol. Os resultados mostraram-se significamente positivos com melhoras nas avaliaçöes imediata aos bloqueios e final tanto para o Escore Geral (E.G.) como para a Escala de Ashword modificada (E.A.M.) com percentuais de melhora de 12,7 por cento, 34,45 por cento para o Escore Geral e de 19,91 por cento e 55,51 por cento para a escala de Ashword modificada.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Anti-Infective Agents, Local/therapeutic use , Muscle Spasticity/drug therapy , Neuromuscular Agents/therapeutic use , Paraparesis, Tropical Spastic/genetics , Paraparesis, Tropical Spastic/drug therapy , Phenol/therapeutic use , Botulinum Toxins, Type A/therapeutic use , Follow-Up StudiesABSTRACT
Idiopatic or HTLV-1 associated progressive spastic paraparesis does not have a clear etiology or treatment. To assess the effects of a medication containing cytidinmonophosphate, uridintriphosphate and vitamin B 12 in the treatment of progressive spastic. Patients with the disease were randomly assigned to receive the Nucleus CMP forte (containing dysodic cytidinmonophosphate 5 mg,trisodic uridintriphosphate 3 mg and hydroxicobalamin 2 mg) tid or placebo during 6 months. Gait, spasticity, degree of neurogenic bladder and somatosensitive evoked potentials were assessed during treatment. Forty six patients aged 25 to 79 years old were studied, 24 were female and 29 HTLV-1 positive. Twenty two were treated with the drug and the rest with placebo. Gait and spasticity improved in 7 of 22 patients receiving the drug and 1 of 24 receiving placebo (p<0.05). Neurogenic bladder improved in 10 of 22 receiving the drug and 4 patients treated with the drug and in two of seven treated with placebo. The medication caused a modest improvement in patients with progressive spastic paraparesis and was free of side effects
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Uridine Triphosphate/administration & dosage , Vitamin B 12/administration & dosage , Cytidine Monophosphate/administration & dosage , Paraparesis, Tropical Spastic/drug therapy , Urinary Bladder, Neurogenic/drug therapy , HTLV-I Infections/complications , HTLV-I Infections/drug therapy , Gait/drug effectsABSTRACT
O comprometimento neurológico é uma complicação não muito freqüente da esquistossomose. O envolvimento das porções inferiores da medula e da cauda equina é o mais comum. São relatados dois casos em que os pacientes apresentaram instalação subaguda de paraparesia com sorologia positiva para esquistossomose no líquido cefalorraqueano. Tratamento foi efetuado com corticosteróides e oxaminiquine.
Subject(s)
Humans , Male , Adult , Central Nervous System Diseases , Paraparesis, Tropical Spastic , Schistosomiasis mansoni , Adrenal Cortex Hormones/therapeutic use , Central Nervous System Diseases/cerebrospinal fluid , Central Nervous System Diseases/drug therapy , Glucocorticoids/therapeutic use , Paraparesis, Tropical Spastic/drug therapy , Prednisone/therapeutic use , Schistosomiasis mansoni/cerebrospinal fluid , Schistosomiasis mansoni/drug therapyABSTRACT
A mielopatia associada ao protovírus T-linfotrópico humano (HTLV-1), também conhecida como paraparesia espástica tropical associada ao HTLV-I (MAH/PET), constitui enfermedade imunomediada desencadeada pela infecçäo pelo HTLV-I. Nesta condiçäo tem sido demonstrada, particularmente em pacientes japoneses, boa resposta clínica à terapêutica com corticosteróides. Este efeito benéfico todavia näo foi encontrado em todas as regiöes do mundo. Pulsoterapia com metilprednisolona endovenosa tem sido utilizada com sucesso em pacientes com esclerose múltipla, outro exemplo de doença auto-imune do sistema nervoso central, especialmente durante as fases de exacerbaçäo da doença. Objetivando testar a eficácia da pulsoterapia com metilprednisolona em pacientes com MAH/PET, conduzimos estudo aberto em 23 doentes. Näo constatamos efeito benéfico significativo desta forma de tratamento na maioria dos enfermos estudados. Apenas um dos pacientes, o qual exibia o menor tempo de duraçäo de doença (cinco meses), obteve benefício a longo prazo. Acreditamos que tratamento imunossupressivos devam ser de maior utilidade naqueles doentes com menor tempo de evoluçäo, nos quais, possivelmente, há preponderância do processo inflamatório sobre o desmielinizante
Subject(s)
Humans , Male , Female , Methylprednisolone/administration & dosage , Paraparesis, Tropical Spastic/drug therapy , Deltaretrovirus Antibodies/analysis , Injections, Intravenous , PrognosisABSTRACT
Investigamos a eficácia do danazol, um andrógeno sintético, no tratamento de 5 mulheres e 3 homens com mielopatia associada a HTLV-1. Dentro do período de 15 dias após o início da administraçäo da droga houve melhora significativa do controle urinário e aumento da força muscular em membros inferiores. Os resultados clínicos obtidos foram mais pronunciados em mulheres que em homens