Abstract
The human T-lymphotropic virus type 1 (HTLV-1) is a RNA retrovirus that infects a minimum of 5–10 million people worldwide. Transmission by cell-containing blood products and solid organ transplantation has been reported. Clinical disease occurs in about 5–10% of infected individuals and consists mainly in adult T cell leukemia and HTLV-1-associated myelopathy (HAM). We present a 54-year-old woman who underwent kidney transplant from cadaveric donor in March 2015. Donor also underwent cornea extraction for another recipient (corneal transplant protocol includes HTLV-1/2 serology). Twenty-four hours after completion of kidney transplant donor, HTLV-1 serology was revealed positive. Following experts’ recommendations, once donor seropositivity was demonstrated, antiviral prophylaxis including zidovudine and raltegravir was initially given to our patient, in spite of which the patient developed HAM. Once the diagnosis of HAM was established, antiretroviral therapy was restarted, and intravenous pulses of methylprednisolone were periodically administered with transient initial improvement. Later on, the patient experienced neurological deterioration becoming wheelchair dependent. Since the occurrence of this case, HTLV-1 screening has become mandatory for solid organ transplantation in the Spanish province of Navarra, and the same should happen worldwide.
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References
Armstrong MJ, Corbett C, Rowe IA, Taylor GP, Neuberger JM (2012) HTLV-1 in solid-organ transplantation: current challenges and future management strategies. Transplantation 94:1075–1084
Cook LB, Melamed A, Demontis MA, Laydon DJ, Fox JM, Tosswill JH, de Freitas D, Price AD, Medcalf JF, Martin F, Neuberger JM, Bangham CR, Taylor GP (2016) Rapid dissemination of human T-lymphotropic virus type 1 during primary infection in transplant recipients. Retrovirology 13:3
Gessain A, Cassar O (2012) Epidemiological aspects and world distribution of HTLV-1 infection. Front Microbiol 3:388
Gout O, Baulac M, Gessain A, Semah F, Saal F, Périès J, Cabroi C, Foucault-Fretz C, Laplane D, Sigaux F, de Thé G (1990) Rapid development of myelopathy after HTLV-I infection acquired by transfusion during cardiac transplantation. N Engl J Med 322:383–388
Gövert F, Krumbholz A, Witt K, Hopfner F, Feldkamp T, Korn K, Knöll A, Jansen O, Deuschl G, Fickenscher H (2015) HTLV-1 associated myelopathy after renal transplantation. J Clin Virol 72:102–105
Hill SA, Lloyd PA, McDonald S, Wykoff J, Derse D (2003) Susceptibility of human T cell leukemia virus type I to nucleoside reverse transcriptase inhibitors. J Infect Dis 188(3):424–427
Manns A, Hisada M, La Grenade L (1999) Human T-lymphotropic virus type 1 infection. Lancet 353(9168):1951–1958
Ramanan P, Deziel PJ, Norby SM, Yao JD, Garza I, Razonable RR (2014) Donor-transmitted HTLV-1-associated myelopathy in a kidney transplant recipient—case report and literature review. Am J Transplant 14:2417–2421
Toro C, Rodés B, Poveda E, Soriano V (2003) Rapid development of subacute myelopathy in three organ transplant recipients after transmission of human T-cell lymphotropic virus type I from a single donor. Transplantation 75(1):102–104
Toro C, Soriano V, Grupo Español de Estudio del VIH-2 y HTLV-1/2 (2005) Current status of HIV-2 and HTLV-1/2 infection in Spain: lights and shades. Med Clin (Barc) 124(16):616–617
Zarranz Imirizaldu JJ, Gomez Esteban JC, Rouco Axpe I, Perez Concha T, Velasco Juanes F, Allue Susaeta I, Corral Carranceja JM (2003) Post-transplantation HLTV-1 myelopathy in three recipients from a single donor. J Neurol Neurosurg Psychiatry 74(8):1080–1084
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Study concept (DMA, PM, JGPL), acquisition of data (DMA, JRY, JGPL), manuscript writing (DMA, JGPL), critical revision (JRY, PM, JGPL).
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Moreno-Ajona, D., Yuste, J.R., Martín, P. et al. HTLV-1 myelopathy after renal transplant and antiviral prophylaxis: the need for screening. J. Neurovirol. 24, 523–525 (2018). https://doi.org/10.1007/s13365-018-0627-3
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DOI: https://doi.org/10.1007/s13365-018-0627-3