Dermatologic manifestations in HTLV-1-associated myelopathy/tropical spastic paraparesis

  • Reza Boostani Department of Neurology, Quaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
  • Pouran Layegh
  • Mohammad Javad Yazdanpanah Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
  • Elham Vosoughi
  • Azadeh Mohammadi
  • Noseibe Joneidi
  • Reyhaneh Bazargani
  • Delaram Sayadpour Zanjani
  • Saeed Ebrahimzadeh
Keywords: HTLV-1, HTLV-1 Associated Myelopathy (HAM), Tropical spastic paraparesis (TSP), Skin Lesions


Background: The human T cell lymphotropic virus type-1 ( HTLV-1) is associated  with  adult  T cell  leukemia/lymphoma (ATL) and other  disorders, including  a slowly progressive  demyelinating paraparesis, known as HTLV-1-associated myelopathy/tropical spastic  paraparesis  ( HAM/TSP). Dermatologic manifestations are common in patients infected with HTLV-1 infection. In this study, we evaluated the dermatologic lesions associated with HAM/TSP patients in Mashhad.

Methods: Dermatological  findings  of  37  patients  with  HAM/TSP  were  investigated  and  were  compared  with  those of a  HTLV-1 negative control  group. Cutaneous biopsy was performed as needed and the results were statistically analyzed.

Result: Results of the present study showed that 34 cases with HAM/TSP (91.9%) and 24 cases in control group (64.9%) had at least one skin lesion or history of skin lesion before (p=0.010). Xerosis was found in 22 persons (59.5%) in the case group and 4 persons in the control group (10.8%) (p=0.000). Only Xerosis was significantly associated with HAM/TSP.  

Conclusion: Skin manifestations were quite frequent in the patients with HAM/TSP. Xerosis was significantly associated with HAM/TSP.


Proietti FA, Carneiro-Proietti AB, Catalan-Soares BC, Murphy EL. Global epidemiology of HTLV-I infection and associated diseases. Oncogene 2005;24:6058-68.

Matsuoka M. Human T-cell leukemia virus type I and adult T-cell leukemia. Oncogene 2003;22:5131-40.

LaGrenade L, Hanchard B, Fletcher V, Cranston B, Blattner W. Infective dermatitis of Jamaican children: a marker for HTLV-I infection. Lancet 1990;336:1345-7.

Lenzi ME, Cuzzi-Maya T, Oliveira AL, Andrada-Serpa MJ, Araújo AQ. Dermatological findings of human T lymphotropic virus type 1 (HTLV-I)-associated myelopathy/tropical spastic paraparesis. Clin Infect Dis 2003;36:507-13.

Blas M, Bravo F, Castillo W, et al. Norwegian scabies in Peru: the impact of human T cell lymphotropic virus type I infection. Am J Trop Med Hyg 2005;72:855-7.

Tokura Y, Sawada Y, Shimauchi T. Skin manifestations of adult T-cell leukemia/lymphoma: clinical, cytological and immunological features. J Dermatol 2014;41:19-25.

Rafatpanah H, Hedayati-Moghaddam MR, Fathimoghadam F, Bidkhori HR, Shamsian SK, Ahmadi S, et al. High prevalence of HTLV-I infection in Mashhad, Northeast Iran: a population-based seroepidemiology survey. J Clin Virol 2011;52:172-6.

Matsuzaki T, Nakagawa M, Nagai M, Usuku K, Higuchi I, Arimura K, et al. HTLV-I proviral load correlates with progression of motor disability in HAM/TSP: analysis of 239 HAM/TSP patients including 64 patients followed up for 10 years. J Neurovirol 2001;7:228-34.

Gonçalves DU, Guedes AC, Proietti AB, Martins ML, Proietti FA, Lambertucci JR, et al. Dermatologic lesions in asymptomatic blood donors seropositive for human T cell lymphotropic virus type-1. Am J Trop Med Hyg 2003;68:562-5.

Hanchard B. Outcomes of early life exposure to human T cell lymphotropic virus type 1. Clin Infect Dis 2005;41:542-3.

Okajima R, Oliveira AC, Smid J, Casseb J, Sanches JA Jr. High prevalence of skin disorders among HTLV-1 infected individuals independent of clinical status. PLoS Negl Trop Dis 2013;7:e2546.

Bittencourt AL, de Oliveira Mde F. Cutaneous manifestations associated with HTLV-1 infection. Int J Dermatol 2010;49:1099-110.

Roucoux DF, Wang B, Smith D, Nass CC, Smith J, Hutching ST, et al. A prospective study of sexual transmission of human T lymphotropic virus (HTLV)-I and HTLV-II. J Infect Dis 2005;191:1490-7.

Alamy AH, Menezes FB, Leite AC, Nascimento OM, Araújo AQ. Dysautonomia in human T-cell lymphotrophic virus type I-associated myelopathy/tropical spastic paraparesis. Ann Neurol 2001;50:681-5.

Setoyama M, Kerdel FA, Elgart G, Kanzaki T, Byrnes JJ. Detection of HTLV-1 by polymerase chain reaction in situ hybridization in adult T-cell leukemia/lymphoma. Am J Pathol 1998;152:683-9.

How to Cite
Boostani R, Layegh P, Yazdanpanah MJ, Vosoughi E, Mohammadi A, Joneidi N, Bazargani R, Sayadpour Zanjani D, Ebrahimzadeh S. Dermatologic manifestations in HTLV-1-associated myelopathy/tropical spastic paraparesis. Acta Med Iran. 57(3):180-183.