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Arquivos de Neuro-Psiquiatria

versão impressa ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.53 no.4 São Paulo dez. 1995

http://dx.doi.org/10.1590/S0004-282X1995000500011 

HTLV-I Associated uveitis, myelopathy, rheumatoid arthritis and Sjögren's syndrome

 

Uveite, mielopatia, artrite reumatóide e sindrome de Sjogren associadas ao HTLV-I

 

 

Sônia Regina A. A. PinheiroI; Marco Aurélio Lana-PeixotoII; Anna B. Carneiro ProiettiIII; Fernando OréficeI; Maria V. Lima-MartinsIII; Fernando A. ProiettiIV

IDepartments of Ophthalmology
IINeurology
IIIFederal University of Minas Gerais Medical School and State Center of Hematology and Hemotherapy (Fundação Hemominas); Belo Horizonte, MG, Brazil
IVPreventive and Social Medicine

 

 


SUMMARY

A 62 year-old white female presented with a 10-year-history of slowly progressive spastic paraparesis, pain and dysesthesia in the lower limbs and sphincter disturbance. A few years after the onset of the neurologic symptoms she developped migratory arthritis with swelling of the knees and pain on palpation of knees and fingers, dry eyes, mouth and skin. Two months before admission she presented bilateral nongranulomatous anterior uveitis. Examination revealed spastic paraparesis with bilateral Babinski sign, a decreased sensation level below L3, decreased vibration sense in the lower extremities, and a postural tremor of the upper limbs. Laboratory work-up disclosed HTLV-I positive tests in the blood and cerebrospinal fluid (CSF), and a mild pleocytosis in the CSF with a normal protein content. Nerve conduction velocity studies were normal. The present case shows the association of uveitis, arthritis and Sjögren's syndrome in a patient with tropical spastic paraparesis / human T-cell lymphotropic virus type I (HTLV-I) associated myelopathy (TSP/HAM), and illustrates the wide spectrum of clinical manifestations which may accompany this infection with this virus.

Key words:HTLV-I/II, uveitis, myelopathy, spastic paraparesis, Sjögren's syndrome.


RESUMO

Uma mulher branca de 62 anos foi internada apresentando história de paraparesia lentamente progressiva durante 10 anos. Dois meses antes da internação ela apresentou uveíte anterior não granulomatosa bilateral. Poucos anos após o início dos sintomas neurológicos, ela desenvolveu artrite migratória com edema dos joelhos e dor a palpação dos joelhos e dedos dos pés, boca, pele e olhos secos. Ao exame físico foi observado paraparesia espástica com sinal de Babinski positivo, sensibilidade diminuída abaixo de L3, diminuição da sensação de vibração nas extremidades inferiores, e tremor postural dos membros superiores. Apresentou testes positivos para o HTLV-I no sangue. O estudo do líquido cefalorraquidiano mostrou discreta pleocitose, proteínas normais e ELISA e Western blot positivos para o HTLV-I. O estudo da velocidade de condução dos nervos foi normal. Este caso mostra a associação de uveíte, artrite e síndrome de Sjogren em uma paciente com paraparesia espástica tropical (HTLV-I) associada a mielopatia (TSP/HAM), e ilustra o largo espectro das manifestações clínicas que podem acompanhar a infecção por este vírus.

Palavras-chave:HTLV-I/II, uveite, mielopatia, paraparesia espástica, síndrome de Sjogren.


 

 

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Aceite: 27-junho-1995.

 

 

Dra. Sônia Regina A. A. Pinheiro - Rua São Paulo 409/601 - 30170-130 Belo Horizonte MG - Brasil. FAX 031 2918526.