Abstract Details

Title Rapidly Progressive HTLV-1 Associated Myelopathy after Immune Checkpoint Inhibitor Therapy

Topic Infectious Disease

Presentation(s) P2 - Poster Session 2 (2:45 PM-3:45 PM)

Poster/Presentation
Number 064

Objective

We describe a case of rapidly progressive Human T-lymphotropic virus type 1 (HTLV-1) associated myelopathy (HAM) after immune checkpoint inhibitor (ICI) therapy

Background HTLV-1 infection is relatively prevalent worldwide particularly in endemic regions though most patients remain asymptomatic carriers. About 5% of HTLV-1 carriers develop adult T-cell leukemia/lymphoma and 1% develop HAM which usually has slowly progressive course. A few cases of rapid progression of adult T-cell leukemia-lymphoma have been reported shortly after ICI therapy initiation, while no such associations have been reported for HAM.

Design/Methods NA

Results A 40-year-old Jamaican female with personal medical history of invasive ductal carcinoma treated with chemotherapy, resection and maintenance immunotherapy with pembrolizumab was transferred from outside hospital with progressive myelopathy. Symptoms started after curative surgery and while on pembrolizumab with progressive low back pain, paresthesias progressing to numbness with T10 sensory level, spastic paraparesis and bowel/bladder dysfunction with progression to wheel chair over 4 months. MRI revealed longitudinally extensive non-enhancing dorsolateral white matter spinal cord lesion. Serum studies significant for low copper, vitamin E and B6. Infectious workup positive for latent tuberculosis, urinary tract infection and positive HTLV-I test. CSF studies significant for mild lymphocytic pleocytosis, elevated IgG index and positive CSF HTLV-I. Patient had limited improvement with pulse steroids and plasma apheresis. While she had other factors contributing to her symptoms and ICI-associated inflammatory myelopathy could not be excluded, patient met criteria for HAM.

Conclusions

While rapidly progressive HAM has been described, the risk factors and biomarkers are unknown. In the era of emerging immunotherapies including ICI which are more commonly associated with autoimmune myelopathies, HAM should be suspected in the right clinical context and pre-treatment asymptomatic carrier screening might be warranted in the future.

Authors/Disclosures
Marina Buciuc, MD PRESENTER	Dr. Buciuc has nothing to disclose.
Robert Wildman, MD (MUSC)	Dr. Wildman has nothing to disclose.

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