Chronic progressive myelopathy associated with elevated antibodies to human T‐lymphotropic virus type I and adult T‐cell leukemialike cells

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Abstract
Six adult patients had a chronic progressive myelopathy that possessed the following features: (1) high antibody titers to human T-lymphotropic virus type I (HTLV-I) in serum and cerebrospinal fluid (CSF); (2) predominantly upper motor neuron disorder, symmetrical, with mild sensory and bladder disturbances; and (3) presence of adult T-cell leukemia–like cells in both peripheral blood and CSF. We refer to this entity as HTLV-I–associated myelopathy (HAM). Electrophoretic studies of immunoglobulin G in CSF using Western blot analysis characteristically demonstrated p24 and p32 bands. Rates of intra-blood–brain barrier synthesis were determined and found increased in the patients with HAM. Corticosteroid treatment produced clinical improvement in all of 4 patients. A retrospective survey of CSF samples was carried out in 287 patients with neurological disorders, and 6 additional patients with HAM were identified.