Male, 58 years old at the time of transplantation on 5 October 1998.
On peritoneal dialysis since January of the same year due to progressive CKD secondary to IgA glomerulonephritis with associated focal and segmental sclerosis diagnosed in 1984.
Other antecedents of interest: arterial hypertension diagnosed in 1982, under pharmacological treatment, ischaemic heart disease due to coronary artery disease with transluminal angioplasty of the right coronary artery in 1994 (since then asymptomatic, subsequent stress tests negative), type II dyslipidaemia. He underwent surgery for bilateral cryptorchidism and tonsillectomy in his youth.
Renal transplant was uneventful (left kidney in right iliac fossa with 2 arteries in single patch and vein leading to external iliac), with immediate effective graft function, no acute rejection and high levels of cyclosporine with no apparent clinical toxicity. The patient received treatment with cyclosporine 8mg/kg, mycophenolate mofetil 2g/day, and prednisone 1mg/kg, with figures progressively decreasing in subsequent controls.
In September 2000 (2 years after the transplant), the patient reported for the first time a feeling of instability when walking and trembling in his hands, which progressively increased, and a study was started by the neurology department. At the time of the study, the patient had gait instability, paraesthesia in both lower limbs (lower extremities) and hand tremors. Physical examination showed no motor deficit but decreased vibration sensitivity in both LES, vivid osteotendinous reflexes (OTR) and cutaneoplantar reflex (CPR) in extension. Magnetic resonance imaging (MRI) showed no lesions at cerebral or spinal level, cerebrospinal fluid (CSF) analysis showed lymphocytic pleocytosis without oligoclonal bands, evoked potentials were altered at tibial level and serological tests, ELISA, and polymerase chain reaction (PCR) were positive for HTLV-I in CSF and blood in the first case and PCR in blood. A high viral load was demonstrated.
The patient was diagnosed with tropical spastic paraparesis (TSP), and despite repeated pulses of 6-Methyl-Prednisolone, he is progressively evolving. He has refused treatment with interferon due to the possibility of transplant rejection, and his renal function has always been correct, with creatinine levels oscillating between 1-1-2.
He was studied by our department due to urinary urgency with occasional leakage and dribbling. A radiographic and urodynamic study confirmed the existence of a hyperrefléxic bladder and a large bladder lithiasis which was removed by cystolithotomy without postoperative incidents in December 2003.
The patient is currently dependent for basic functions of daily life such as toileting, ambulation (he moves around in a wheelchair), feeding (he is not able to hold a spoon).