Elsevier

Journal of Clinical Virology

Volume 72, November 2015, Pages 102-105
Journal of Clinical Virology

Case report
HTLV-1 associated myelopathy after renal transplantation

https://doi.org/10.1016/j.jcv.2015.09.010Get rights and content

Highlights

  • HTLV-1 is rarely transmitted via kidney transplantation from donor to recipient.

  • We report a case of HTLV-1 myelopathy contracted by kidney transplantation.

  • The clinical and virus laboratory findings are presented and discussed in detail.

  • In contrast, two other organ recipients rapidly developed T-cell lymphoma.

  • The HTLV-1 status needs more attention prior to solid organ transplantation.

  • This is also relevant for low prevalence countries.

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.

References (31)

  • K. Tanabe et al.

    Long-term results in human T-cell leukemia virus type 1-positive renal transplant recipients

    Transplant. Proc.

    (1998)
  • P. Ramanan et al.

    Donor-derived HTLV-1 associated myelopathy after transplantation: a call for targeted screening

    Am. J. Transplant.

    (2015)
  • F. Tedla et al.

    Risk of transmission of human T-lymphotropic virus through transplant

    Am. J. Transplant.

    (2015)
  • I. Glowacka et al.

    Delayed seroconversion and rapid onset of lymphoproliferative disease after transmission of HTLV-1 from a multi organ donor

    Clin. Infect. Dis.

    (2013)
  • A. Liesz et al.

    HTLV-1-associated myelopathy/tropical spastic paraparesis: a differential diagnosis in multiple sclerosis

    Nervenarzt

    (2012)
  • Cited by (10)

    View all citing articles on Scopus
    1

    These authors contributed equally to this work.

    View full text