Bronchoalveolar Lymphocytosis in Patients with Tropical Spastic Paraparesis Associated with Human T-Cell Lymphotropic Virus Type 1 (HTLV-1)

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Abstract
Study Objective: To determine the features of pulmonary involvement in patients with tropical spastic paraparesis associated with human T-cell lymphotropic virus type 1. Design: Nonrandomized prospective case series. Setting: Tertiary care units in two university medical centers. Patients: Consecutive sample of 21 patients with tropical spastic paraparesis associated with human T-cell lymphotropic virus type 1 infection. Interventions: Chest roentgenogram and bronchoalveolar lavage were done in all patients. Fifteen patients had pulmonary function tests. Alveolar T-lymphocyte subsets were analysed in 10 patients and thoracic computed tomographic scans were done in 10 patients. Measurements and Main Results: All patients were free of clinical pulmonary symptoms and had normal chest roentgenograms. Thoracic computed tomographic scans were normal in 9 of 10 patients and showed mild interstitial pneumonitis in 1. Pulmonary function tests were within the normal range in 13 patients and showed a mild restrictive syndrome in 2. Eighteen patients had increased absolute numbers of alveolar lymphocytes (mean, 77 .+-. 39 .times. 103 lymphocytes/mL; range, 13.5 .times. 103 to 259 .times. 103 lymphocytes/mL). Sixteen patients had percentages of alveolar lymphocytes higher than 20% of all alveolar cells (mean, 33.5 .+-. 12.7; range 9 to 69). In all 10 patients tested, 64.2% .+-. 13.2% of alveolar lymphocytes were CD8 + cells. Conclusion: Excessive absolute numbers and percentages of alveolar lymphocytes were observed in 18 and 16 patients, respectively. Most alveolar lymphocytes were CD8 + cells.

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