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Tropical spastic paraparesis-like illness occurring in a patient dually infected with HIV-1 and HTLV-II

Departments of Neurology (Dr. Berger) and Medicine (Drs. Berger and Raffanti). University of Miami School of Medicine, Miami, FL, and the Department of Retrovirology and Research (Drs. Svenningsson, Raffanti, and Resnick), Mount Sinai Medical Center, Miami Beach, FL.

We describe a 34-year-old man from southern Florida with a history of intravenous drug use, dually infected with human immunodeficiency virus type 1 (HIV-1) and human T-lymphotropic virus type II (HTLV-II), who developed a myelopathy clinically indistinguishable from HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP). This myelopathy was characterized by spastic lower extremity weakness, distal paresthesias, sensory loss with a discrete thoracic level to pinprick, back pain, impotence, and sphincter disturbances. Nerve conduction studies revealed an associated mixed axonal and demyelinative neuropathy. Despite a lack of response to 10 months of zidovudine therapy, the myeloneuropathy improved dramatically 2 years after its onset in the absence of any therapeutic intervention.

Address correspondence and reprint requests to Dr. Joseph R. Berger, Department of Neurology, University of Miami School of Medicine, 1501 N.W. 9th Avenue, Miami, FL 33136.

Supported by grant PO1 NS 25569-01 from the National Institute of Neurological Disorders and Stroke.

Received May 7, 1990. Accepted for publication in final form June 28, 1990.

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