A 66-year-old woman was referred to our department for uveitis in the right eye which had been present for a year. The patient reported decreased vision in this eye but no myodesopsia or metamorphopsia. Her medical history included an intracranial haemorrhage twelve years ago, which required surgery and transfusion of two units of red blood cell concentrate.

In the ophthalmological examination, the best corrected visual acuity (BCVA) was 8/20 in the right eye and 10/20 in the left eye. Slit-lamp examination showed cellular debris in the vitreous with no signs of activity. Fundus examination showed epimacular membrane in both eyes, no signs of retinal vasculitis, snowballs or snowbanks. Optical coherence tomography confirmed the epimacular membrane. Intermediate uveitis of unknown aetiology was diagnosed.

In the following months the patient developed progressive weakness in the lower limbs and became unable to walk. She also consulted for an episode of vitritis ++ that subsided with transseptal triamcinolone (TRIGON depot).

In the aetiological study, after ruling out other causes of the neurological symptoms, with normal MRI, given the association of uveitis and idiopathic myelopathy with patellar hyperreflexia, serology was requested for VLHT-1, which was positive by enzyme immunoassay (EIA) for the detection of antibodies against VLHT-1 (ABBOTT HTLV-1/HTLV-2, Innogenetics N.V.). EIA samples were tested by strip immunoblot (INNO-LIATM HTLV I/II, Innogenetics N.V.) which confirmed the presence of antibodies to HTLV-1. The diagnosis of tropical spastic paraparesis and intermediate uveitis due to HTLV-1 was then established. Treatment with oral prednisone was prescribed, improving his neurological symptoms as well as his CVAM, reaching a vision of 14/20 in the right eye and 18/20 in the left eye.