A case of HTLV-1 associated adult T-cell lymphoma presenting with cutaneous lesions and tropical spastic paresis.

Adult T cell lymphoma (ATL), is a peripheral T cell neoplasm associated with infection by human T-lymphotropic virus (HTLV). This is a case of a 28-year-old lady who presented with back pain for the past month and recent onset weakness in her lower extremities bilaterally. She has a history of T-cell lymphoma secondary to HTLV-1 under remission since 2014 and systemic lupus erythematosus complicated by lupus nephritis. On physical examination patient had hyper-reflexia in both knees, ankle clonus bilaterally and spasticity in both her lower extremities. She also had a diffuse, scaly, macular rash in her upper and lower extremities and ulcer-like lesions on the plantar surface of both feet. Her lumbar puncture showed lymphocyte predominance. The Western Blot test was positive for HTLV antibodies in the CSF. The patient was started on IV Methylprednisone which considerably improved her symptoms. The biopsy of her skin lesions showed an immunophenotype of T-cells similar to the cells in the bone marrow at the time of diagnosis of the lymphoma. HTLV infection is an etiologic agent for ATL as well as for tropical spastic paresis. One should have a high degree of suspicion for tropical spastic paresis in patients with HTLV-1 infection as it can easily go undiagnosed. Indolent forms of ATL can also present in the form of skin lesions in later stages. It is also important to distinguish between skin manifestations of ATL and cutaneous T cell lymphomas, and the importance of skin biopsies for the same cannot be undermined.

Prevalencia de HBsAg y HBeAg en mujeres embarazadas del área metropolitana de Caracas / Incidence of HBsAG and HBeAg in pregnant women of the metropolitan area of Caracas

La prevalencia de portadores sanos de HBsAg en 840 mujeres embarazadas que asisten a la consulta prenatal del HUC es del 2.7% y del HBeAg 0%. Del total de 23 madres positivas han nacido hasta el momento 14 niños, que al control, sus respectivos HBsAg permanecen negativos después de haber recibido HB-VAX con o sin HBIG. Consideramos que las madres estudiadas provienen en su mayoría de estratos socio-economicos bajos por lo que son de alto riesgo, por lo tanto, el despistaje mediante la determinación de HBsAg en todas las embarazadas disminuiría el riesgo de transmisión perinatal, y el uso de la vacúna, aun sin HBIG, dado el 100% de negatividad para HBeAg, pudiera ser adecuado a un bajo costo en la profilaxis de la hepatitis a virus B en la mayoría de recién nacidos a riesgo