HTLV-1-associated infective dermatitis and probable HTLV-1- associated myelopathy in an adolescent female

Human T cell lymphotropic virus type 1 (HTLV-1)-associated infective dermatitis (ID) is a chronic, severe and recurrent eczema occurring during childhood in patients vertically infected with HTLV-1. HTLV-1-associated myelopathy/tropical spastic paraparesia (HAM/ TSP) is slow and progressive. We report the case of an adolescent female from a non-endemic area for HTLV-1 who presents ID and, most likely, associated HAM/TSP.

Keywords:
Dermatitis; Demyelinating diseases; Human T-lymphotropic virus 1; Paraparesis, tropical spastic

Authorship

Raquel Bisacotti Steglich

Universidade da Região de Joinville (UNIVILLE) – Joinville (SC), Brazil.Universidade da Região de JoinvilleBrazilJoinville, SC, BrazilUniversidade da Região de Joinville (UNIVILLE) – Joinville (SC), Brazil.

Renata Elise Tonoli MAILING ADDRESS: Renata Elise Tonoli, Rua Prof. Annes Dias, 285 - Centro, 90020-090 - Porto Alegre - RS, Brazil. E-mail:retonoli@hotmail.com

Santa Casa de Misericórdia de Porto Alegre – Porto Alegre (RS), Brazil.Santa Casa de Misericórdia de Porto AlegreBrazilPorto Alegre, RS, BrazilSanta Casa de Misericórdia de Porto Alegre – Porto Alegre (RS), Brazil.

Paulo Ricardo Martins Souza

Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) – Porto Alegre (RS), Brazil.Pontifícia Universidade Católica do Rio Grande do SulBrazilPorto Alegre, RS, BrazilPontifícia Universidade Católica do Rio Grande do Sul (PUCRS) – Porto Alegre (RS), Brazil.

Giselle Martins Pinto

Rudimar dos Santos Riesgo

Universidade Federal do Rio Grande do Sul (UFRGS) – Porto Alegre (RS), Brazil.Universidade Federal do Rio Grande do SulBrazilPorto Alegre, RS, BrazilUniversidade Federal do Rio Grande do Sul (UFRGS) – Porto Alegre (RS), Brazil.

MAILING ADDRESS: Renata Elise Tonoli, Rua Prof. Annes Dias, 285 - Centro, 90020-090 - Porto Alegre - RS, Brazil. E-mail:retonoli@hotmail.com

Conflict of Interest: None.

SCIMAGO INSTITUTIONS RANKINGS

Figures | Tables

Figures (4)
Tables (2)

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FIGURE 1
Yellowish, adherent crusts on the scalp

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FIGURE 2
Retroauricular eczema and erythematous scaly rash on the scalp

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FIGURE 3
Micropapular rash on the trunk

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FIGURE 4
Histopathology of the scalp: moderate psoriasiform acanthosis, parakeratosis and mild spongiosis. Immunohistochemistry: lymphocytic infi ltrate with a predominance of CD8 + lymphocytes in the dermis

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CHART 1
Diagnostic Criteria of Osame et al HAM/ TSP (1986)

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CHART 2
Diagnostic criteria of infectious dermatitis

FIGURE 1 Yellowish, adherent crusts on the scalp

FIGURE 2 Retroauricular eczema and erythematous scaly rash on the scalp

FIGURE 3 Micropapular rash on the trunk

FIGURE 4 Histopathology of the scalp: moderate psoriasiform acanthosis, parakeratosis and mild spongiosis. Immunohistochemistry: lymphocytic infi ltrate with a predominance of CD8 + lymphocytes in the dermis

CHART 1 Diagnostic Criteria of Osame et al HAM/ TSP (1986)

1.	Definitive HTLV-1 Associated Myelopathy (HAM)
1.1.	Slowly progressive paraparesis, caused by symmetric myelopathy, predominantly involving pyramidal pathways.
1.2.	Anti-HTLV-1
1.3.	Anti-HTLV-1 antibodies present in liquor
2.	Probable HAM
2.1	Paraparesis similar to the described in item 1.1 in patient with anti-HTLV-1 antibodies present in serum or liquor (but not in both) or
2.2	c inconsistent with the definition of item 1.1 in patient with anti-HTLV-1 antibodies present in serum and in liquor simultaneously

Source: Bittencourt AL, 2001¹1 Bittencourt AL, Oliveira MF. Infective Dermatitis Associated to HTLV-I - A Review. An Bras Dermatol. 2001;76:723-732.e Santos FLN, 2005.⁵5 Santos FLN, Lima FWM. Epidemiologia, fisiopatogenia e diagnóstico laboratorial da infecção pelo HTLV-I. J Bras Patol Med Lab. 2005;41:105-16.

CHART 2 Diagnostic criteria of infectious dermatitis

MAJOR CRITERIA
1.	Eczema in two or more areas: scalp, armpits, groin, outer ear, retroauricular region, eyelid margins, perinasal area and/or neck.
2.	Chronic rhinorrhea without other signs of rhinitis and/or crusted lesions in nasal vestibule
3.	Chronic recurrent dermatitis with immediate response to antibiotic therapy but with relapse after cessation of treatment
4.	Onset in childhood
5.	Seropositivity for HTLV-1

MINOR CRITERIA
1.	Positive cultures for Staphylococcus aureus and/or streptococcus β- hemolytic in skin or nostrils
2.	Papulous rash
3.	Generalized lymphadenopathy with dermatopathic lym phadenitis
4.	Anemia
5.	Increased erythrocyte sedimentation rate
6.	Hypergammaglobulinemia IgD and IgE
7.	Increased CD4 and CD8 and CD4/CD8 ratio

The presence of items 1, 2 and 5 among major criteria, and at least two areas of the first item are mandatory to meet criterion 1.

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