Cryptococcal Meningitis in HIV: A Comparative Study Between Asymptomatic and Symptomatic Cases and Mortality Parameters

HTLV-1-associated syndromes is becoming crucial as novel therapies such as mogamulizumab seem to show greatest efficacy when given in low-disability states. Design/Methods N/A. ResultsTwenty published cases of posterior fossa manifestations associated with HTLV-I were identified.Two patients demonstrated acute cerebellar ataxia without other neurologic manifestations of HTLV-1.Otherwise, all patients demonstrated progressive spinal and cerebellar signs (13 with initial cerebellar, 3 with spinal, and 2 with simultaneous onset).Eight documented eye movement abnormalities, including 3 with downbeat nystagmus.Ten patients had cerebellar atrophy.We present a 54-year-old woman from the Dominican Republic with 18 years of symptoms whose examination was notable for spastic paraparesis, absent distal vibration sense, pathologic hyperreflexia, and downbeat nystagmus in all directions of gaze without dysmetria or other cerebellar deficits.MRI showed severe spinal cord atrophy without pontocerebellar atrophy.HTLV-1 antibodies were present in cerebrospinal fluid (CSF) and serum, and extensive testing for autoimmune, nutritional, and other mimics was negative. ConclusionsIn addition to classic manifestations of HTLV-1, it is critical to recognize HSCS in patients from HTLV-endemic regions.Spinocerebellar signs can be the presenting feature of HTLV-1, and recognition could lead to earlier initiation of disease-modifying therapy.