Tropical spastic paraparesis-like illness in an HIV-Infected child

Human T-cell leukemia virus type 1(HTLV-1) is the etiological agent responsible for the clinical entity of tropical spastic paraparesis/HTLV-1-associated myelitis (TSP/HAM). HTLV-1 and HIV-1, being related retroviruses, coinfection with both is a well-recognized phenomenon but rarely reported in children. We describe a 5-year-old boy with no previously known comorbidity who presented with bilateral lower-limb weakness and calf pain along with urinary retention. Imaging confirmed the presence of myelitis. Investigations showed elevated creatine phosphokinase(CPK) values suggestive of myositis. It was later learned that the parents of the child were on treatment for HIV infection. Antibodies for HIV were positive by ELISA, and in view of the clinical picture, probability of a TSP-like illness as the initial presentation of a hitherto undiagnosed HIV infection was considered. TSP/HAM is an important yet underrecognized cause of spinal disease, especially in HIV-infected individuals. Certain features such as elevated to normal CD4 counts, absence of significant sensory symptoms, and associated myositis may serve as subtle clues to underlying HTLV-1 infection.