42-year-old woman at the time of undergoing a liver transplant.
Her personal history prior to the transplant included appendectomy in 1978, liver cirrhosis of probable alcoholic origin diagnosed in 1989, ADH secondary to grade II oesophageal varices in 1996 together with portal hypertension and ascites. In February 1998 she was diagnosed with hepatocarcinoma.
The patient received an uneventful liver transplant in October 1998 and was discharged on treatment with tacrolimus.
Eighteen months after the transplant, the patient reported for the first time weakness of the lower limbs and loss of sensation in them, evolving within two months to complete paraplegia affecting the urinary bladder.
Physical examination revealed paraparesis with amyotrophy due to disuse of the lower limbs, greater subjective hypoaesthesia in DID with level D8-D10, more intense deep sensory impairment in DID, especially at the vibratory level. ROT present, the patellar ones alive and the Achilles hypoactive. Bilateral extensor CPR.
The following diagnostic tests were also performed in this case:
Brain MRI: involvement of the medullary cord from C2 to D10, also presenting hyperintense supratentorial lacunar lesions mainly at the subcortical level of the left frontal lobe and also the right frontal, parietal and occipital lobes.
PEES: pathological at posterior tibial level CSF: sexological determination for HTLV-I positive, rest normal.
Blood test for antibodies (ELISA) and for the existence of the virus (HTLV-I), positive.
The patient was diagnosed with tropical spastic paraparesis and treated with Interferon-á, initially presenting discreet improvement, especially at the distal level of the EEII, although in the last few days the treatment regimen had to be reduced due to an increase in transaminase values. Despite the initial good response, the symptoms have progressively worsened and she is now dependent for daily life and has a permanent bladder catheter after an attempt at bladder re-education by intermittent catheterisation failed. The liver transplant is currently functioning.
In all three cases, transplantectomy was not indicated given the spread of the virus to the blood and nervous systems and the impossibility, given the measures available, of eradicating it and the good function of the transplanted organs.