Cotton wool spots on the retina in patients infected with human t lymphotropic virus type 1 htlv i

Nakao, K.; Uemura, A.; Hirashima, S.; Unoki, K.

Isolated, asymptomatic and transient cotton-wool spots on the retina (CWS) may be one of the ocular manifestations in patients infected with human T-lymphotropic virus type 1 (HTLV-I), a retrovirus that may cause adult T-cell leukemia/lymphoma (ATL) or HTLV-I-associated myelopathy (HAM). This paper reports four cases of such CWS lesions. Case 1: A 58-year-old woman with HAM presented with CWS in one eye with otherwise intact retinochoroid; the aqueous humor of the affected eye showed positivity to anti HTLV-I antibodies. Case 2: A 55-year-old man with highly suspected HAM showed CWS and granulomatous anterior uveitis in one eye; the anterior uveitis was of unknown etiology but responded well to local corticosteroids. Case 3: A 70-year-old woman with HAM presented with isolated CWS in one eye; there was otherwise no apparent retinal vascular change in either eye, although the patient had essential hypertension. Case 4: A 60-year-old man, an HTLV-I carrier who was seropositive for anti HTLV-I antibodies but systematically healthy, had asymptomatic CWS in one eye and progressive vitreous opacities in the other; aspirated vitreous samples were positive for anti HTLV-I antibodies and contained, besides numerous neutrophils, a few atypical lymphocytes with multiple lobulated nuclei, resembling the ATL cells found in patients with ATL.