Case reportHTLV-1 associated myelopathy after renal transplantation
Section snippets
Why this case is important?
Transmission of human T-lymphotropic virus type-1 (HTLV-1) via organ transplantation is rare. Here, we report a case of HTLV-1-associated myelopathy starting four years after kidney transplantation, who has now been observed for five years. Two other organ recipients from the same donor rapidly developed T-cell lymphoma [1]. Thus, the HTLV-1 status needs more attention prior to solid organ transplantation, also in low prevalence countries.
Case description
A 46-year-old female was referred to our Neurology department in December 2012. Since spring 2010, she realized slowly progressive gait impairment and increased urine frequency, without incontinence. She suffered from chronic renal failure since 1990, probably due to IgA glomerulonephritis, and required hemodialysis since 1999. In 2006, she received a renal allograft from a 59-year-old Caucasian male donor with unremarkable medical history. She has received immunosuppressive therapy with
Other similar and contrasting cases in the literature
In Europe, only one further incident of a group of three patients was described, who acquired HTLV-1 infection via organ transplantation and subsequently developed HAM/TSP [3], [4]. In comparison to the three Spanish patients who developed severe progresssive myelopathy within two years after transplantation, our patient has a comparatively mild and rather stable course of disease, although she shows high proviral CSF load and extended spinal-cord lesions under a relatively intensive
Discussion
Human T-lymphotropic virus type-1 (HTLV-1) associated myelopathy or tropical spastic paraparesis (HAM/TSP) is characterized by a slowly progressive spastic paraparesis with impairment of gait, autonomic functions, and sensation [17], [18], [19], [20], [21], [22], [25]. HTLV-1 also causes lymphoma and inflammatory disorders. Approximately 20 million people worldwide are HTLV-1 infected, of which only a small subset becomes symptomatic [16], [17], [19]. HTLV-1 infection is endemic in Southeast
Competing interests
The authors do not have any conflicts of interests.
Funding
This study was supported in part by the Excellence Cluster Inflammation at Interfaces at Kiel.
Ethical approval
The patient provided written informed consent to publish her case history, as recommended by the local Ethics committee of the Medical Faculty at Kiel.
Acknowledgements
The authors thank Dr. T. Doede (DSO, Hamburg) and Dr. C. Kling (Immunology, Kiel) for kindly providing a serum sample of the patient from the year 2006 before transplantation.
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Not the Usual Viral Suspects: Parvovirus B19, West Nile Virus, and Human T-Cell Lymphotrophic Virus Infections After Kidney Transplantation
2016, Seminars in NephrologyCitation Excerpt :The majority of HTLV-1–infected patients are asymptomatic. The two clinical syndromes associated with HTLV-1 are adult T-cell leukemia/lymphoma and HTLV-1–associated myelopathy (also known as tropical spastic paresis).42,51,55,56 Both adult T-cell leukemia/lymphoma and HTLV-1–associated myelopathy have been reported in kidney transplant recipients.
Advances in the treatment of human T-cell lymphotropic virus type-I associated myelopathy
2023, Expert Review of NeurotherapeuticsRapid subacute myelopathy following kidney transplantation from HTLV-1 donors: role of immunosuppresors and failure of antiretrovirals
2019, Therapeutic Advances in Infectious Disease
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These authors contributed equally to this work.