Rapidly Disabling Tropical Spastic Paraparesis Initially Diagnosed as Guillain-Barré Syndrome: A Clinical Challenge for the Intensivist
DOI:
https://doi.org/10.70099/BJ/2025.02.04.8Keywords:
HTLV-1, tropical spastic paraparesis, Guillain-Barré syndrome, myelopathy, Ecuador, case reportAbstract
Human T-cell lymphotropic virus type 1 (HTLV-1) infects 20–30 million individuals worldwide. While most carriers remain asymptomatic, a small percentage develop adult T-cell leukemia or HTLV-1–associated myelopathy/tropical spastic paraparesis (HAM/TSP). We report two young adults in Ecuador initially diagnosed with Guillain-Barré syndrome after acute diarrheal illness. Both patients presented with progressive lower limb weakness, hyperreflexia, spasticity, and sphincter dysfunction, ultimately requiring intensive care unit admission. Extensive diagnostic workup, including neuroimaging, cerebrospinal fluid analysis, and electromyography, ruled out typical Guillain-Barré syndrome. Diagnosis was confirmed by positive HTLV-1 serology and, in one case, spinal cord MRI showing T1/T2 hyperintensities. Clinical evolution was unusually rapid, leading to plegia within days and absence of response to steroids or plasma exchange. These cases highlight the diagnostic challenge posed by TSP in endemic regions, where it can mimic Guillain-Barré syndrome but necessitates a distinct clinical approach.
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