Response to corticosteroid therapy in a patient with HTLV-I-associated motor neuron disease.

Human T-lymphotropic virus type I (HTLV-I)-associated myelopathy/tropical spastic paraparesis (HAM/TSP), or tropical spastic paraparesis (TSP), is an inflammatory disease involving mainly the thoracic spinal cord and is characterized by slowly progressive paraparesis, neurogenic bladder, and mild sensory changes. However, there have been reports of HTLV-I carriers presenting severe muscular atrophy, fasciculation, and pyramidal tract signs without obvious sensory abnormalities.1-4 The features of these patients mimic amyotrophic lateral sclerosis (ALS). This raises the question of whether these patients represent a clinical variant of HAM/TSP or a chance association of HTLV-I infection and ALS. To provide some insight into this issue, we performed a therapeutic trial with corticosteroid in an HTLV-I carrier with an ALS-like manifestation. Case report. A 48-year-old man was admitted to Tenri Hospital because of bilateral hand weakness. He was born and raised on HTLV-I-endemic Kyushu Island.5 At age 36, he developed weakness in all four limbs and sensory loss below both knees 1 week after a flu-like syndrome. He spontaneously recovered from this Guillain-Barre-like syndrome sometime …