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A 49-year-old South African man developed a rapidly progressive myelopathy 14 months after blood transfusion and died 1 year after the onset of symptoms.Detailed pathologic examination of the spinal cord was consistent with the diagnosis of HTLV-I-associated myelopathy/tropical spastic paraparesis(HAM/TSP).Although no HTLV-I viral particles,antigens,or nucleic acids were detected in situ,polymerase chain reaction assays revealed HTLV-I proviral DNA in cervical,thoracic,and lumbar levels of the spinal cord,with the greatest amount being detected at the thoracic level. These findings suggest that the pathogenesis of HAM/TSP depends on direct infection of neural or immune elements within the spinal cord. |
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