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1/7. Localization of retrovirus in the central nervous system of a patient co-infected with HTLV-1 and hiv with HAM/TSP and hiv-associated dementia.

    persons co-infected with HTLV-1 and hiv are at increased risk for neurologic disease. These patients may develop HAM/TSP and/or hiv-associated dementia. In this study, we localized cells infected with retrovirus in the central nervous system (CNS) of a patient with both HAM/TSP and hiv-associated dementia. HTLV-1 was localized to astrocytes and hiv to macrophage/microglia. There was no co-infection of a single cell phenotype in this patient. These data suggest that mechanisms other than co-infection of the same CNS cell may play a role in the development of neurologic disease in patients dual infected with HTLV-1 and hiv.
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2/7. Pathological and virological assessment of acute HTLV-I-associated myelopathy complicated with encephalopathy and systemic inflammation.

    HTLV-I-associated myelopathy, also known as tropical spastic paraparesis (HAM/TSP), is a chronic inflammatory disease of the spinal cord. Acute cases are uncommon. We report the case of a 41-year-old woman with acute HAM/TSP complicated with encephalitis, an intense inflammatory reaction of the nervous system and lymphocytic infiltration of skeletal muscles, liver, salivary, adrenal and pituitary glands. The immunohistochemical studies of the lymphocytes surrounding blood vessels showed both B- and t-lymphocytes, in similar proportion, with both CD4- and CD8-positive cells. In addition, many perivascular and scattered macrophages were observed. adult T-cell leukemia/lymphoma (ATL) was ruled out. The marrow aspirate was normal. Serial cerebrospinal fluid (CSF) analysis showed presence of htlv-i antibodies, but without intrathecal synthesis of specific antibodies. Determination of HTLV-I viral loads demonstrated increased levels in the CSF relative to the peripheral blood and may be associated with widespread inflammation. The pathological and immunological findings may help understand the role of immune-reactive cells in the pathogenesis of HTLV-I-associated myelopathy.
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3/7. Infiltration of helper/inducer T lymphocytes heralds central nervous system damage in human T-cell leukemia virus infection.

    Cellular infiltrates in new and old lesions in two cases of human T-cell leukemia virus associated myelopathy (HAM) were analyzed with anti-CD3 antibody and OPD4 antibody recognizing CD4 CD45RO T lymphocytes. A subset of CD4 lymphocytes with helper/inducer function and labeled with OPD4 constitutes up to 65% of CD3 cells in new lesions in the pons and the cervical cord. In contrast, nonhelper cells and macrophages were dominant in long-standing spinal cord lesions of these HAM cases and inflammatory lesions in two cases of Japanese encephalitis. Thus, unlike in viral infections, the central nervous system (CNS) tissue damage associated with human T-cell leukemia virus (HTLV-1) infection appeared to be heralded by the infiltration of helper/inducer T cells.
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4/7. Pathological observations in HTLV-I associated myelopathy.

    The following are the clinical and autopsy findings in a 63-year-old woman with myelopathy associated with the human T-cell lymphotropic virus Type I (HTLV-I). HTLV-I antibody was positive in both the serum and cerebrospinal fluid (CSF). In the lower thoracic region, demyelination and the loss of axons were accompanied by a proliferation of astrocytes, and gliosis was found in the lateral columns. Perivascular and parenchymal infiltrations of macrophages, lymphocytes, and plasma cells were also observed, but neither viral inclusion bodies nor atypical lymphocytes were found.
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5/7. Human T lymphotropic virus type I associated myelopathy with pulmonary and cutaneous lesions.

    A necropsy case of human T lymphotropic virus I (HTLV-I) associated myelopathy (HAM) in a 64 year old man with serological and genetical confirmation of HTLV-I infection is reported. The spinal cord, lung, and skin were mainly affected. Severe degeneration had occurred in the spinal cord, not only in the lateral columns but also in the anterior and posterior columns. The degenerate lesions showed proliferation of capillaries, loss of myelin and axon, and perivascular and parenchymal infiltration with T lymphocytes and foamy macrophages in the white matter. T lymphocytes had infiltrated the lung and there was vascular proliferation in the peribronchus. OPD4 positive cells predominated in the lung. The patient also had erythrodermia where dense and bandlike HTLV-I infected lymphoid cell infiltration was observed, with mild atypia and epidermotropism. HTLV-I may cause multiorganic inflammatory disorders, although the definitive role of HTLV-I in the pathogenesis is still unknown.
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6/7. Primary xanthoma of thoracic spine presenting with myelopathy.

    STUDY DESIGN. This retrospective case study reports on a patient with an isolated primary xanthoma arising in the second thoracic vertebra with paravertebral and spinal canal extension. OBJECTIVE. The possibility of this lesion's occurrence in the spine is presented with radiologic and pathologic findings appropriate for the diagnosis of spinal xanthoma. SUMMARY OF BACKGROUND DATA. Primary xanthoma of bone is an extremely rare but benign entity. It has not been previously described in this location, and has been described only once in the spine at all. methods. The mass was resected by curettage, and posterior instrumentation was successfully performed. Preoperative radiographs and magnetic resonance imaging of the thoracic spine were performed, as was histologic examination of the lesion. RESULTS. Radiographs of the upper thoracic spine revealed a lytic defect. magnetic resonance imaging revealed a heterogeneous lesion that was enhanced upon the administration of gadolinium-diethylenetriaminetetraacetic acid. Histologic examination revealed a cellular lesion consisting of lipid-laden macrophages, fibroblasts, and scattered Touton giant cells. These features correspond to descriptions of primary xanthoma of bone. Two years after surgery, the patient was neurologically intact with no evidence the lesion would recur. CONCLUSIONS. Primary xanthoma of bone is considered a benign lesion and can be successfully treated by local resection without adjuvant therapy. It should be considered part of the differential diagnosis of a mass lesion, with appropriate signal characteristics presenting in a thoracic vertebra.
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7/7. HTLV-1 polymyositis.

    The case is described of an HTLV-1 seropositive Jamaican woman who presented with signs and symptoms of polymyositis and myelopathy. A muscle biopsy showed features of myositis with a mononuclear inflammatory infiltrate, variation in fibre size and evidence of regeneration. Immunocytochemistry showed the mononuclear cells were composed of macrophages and t-lymphocytes suggesting a cell-mediated response. Multiplex PCR demonstrated the presence of the HTLV-1 tax gene within the muscle.
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