IT IS NOT HIV! IMMUNODEFICIENCY FROM HTLV-1 INFECTION

Abstract

Introduction Human T-Lymphotropic Virus Type 1 (HTLV-1) is a retrovirus affecting CD4+ T cells. It is most prevalent in Japan; however, incidence is increasing in the US. HTLV-1 is associated with development of adult T-cell leukemia/lymphoma and an inflammatory myelopathy referred to as HTLV-1 associated myelopathy-tropical spastic paraparesis (HAM-TSP). HTLV-1 increases the risk of opportunistic infections via dysregulation of CD4+ cells. Case Description A 58-year-old female was referred for a low CD4+ count following an extensive work-up for non-specific symptoms. Two years prior she was well and ran a 5K. A few months afterwards, she developed joint pain and generalized weakness which progressed rapidly to the point where she was wheelchair-bound within a couple of months. An EGD obtained for GI discomfort demonstrated candida esophagitis. A neurology work up was negative for any clear myelopathy, radiculopathy, peripheral neuropathy or myopathy. MRI/MRA brain was largely normal. A QuantiFERON gold test was positive and she was treated for latent tuberculosis. She was found to have peripheral eosinophilia and strongyloides was positive and treated. She had evidence of lymphopenia with associated low CD4 count. Given her symptoms of recurrent infections in combination with spastic paralysis, HTLV1 was checked and was positive. Discussion HTLV-1 is a viral infection with growing incidence that can result in immunosuppression with increased risk of infection and malignancy. This rising viral illness may result in lymphopenia with low CD4 count and it is important to consider in immunodeficiency work-ups.