| A 51-year-old woman, right monorene, included in a hemodialysis program 9 months prior to transplantation for CKD secondary to right chronic pyelonephritis. | |
| Personal history: left nephrectomy for pararenal abscess secondary to rupture of the left kidney containing staghorn calculus and right upper gastrointestinal calculus in right pelvic ureter in February 1990. Hypertriglyceridemia Service, fat diet. | |
| Right kidney transplant in the right iliac fossa was uneventful (also a double renal artery with a single patch and vascular anastomosis to external iliacs, a Paquin-type ureter implant). | |
| The patient presented on day +5 of the transplant acute rejection being treated with pulses of 6-Methyl-Prednisolone (400mg/day, 3 days) and was discharged with creatinine levels between 0'1. | |
| At discharge the patient was also treated with cyclosporine 8mg/Kg, mycophenolate mofetil 2gr/day and prednisone 1mg/Kg. | |
| In April 1999, 6 months after transplantation, the patient complained of tremor in both hands, which was initially attributed to cyclosporine toxicity and started to decrease the corticosteroid regimen. | |
| However, due to the worsening of the condition, after an asymptomatic year, a study was initiated by the Neurology Department. | |
| At that time, one and a half year after transplantation (March 2000), the patient presented gait instability, tremors and paresthesias in the lower limbs. | |
| Physical examination showed moderate pyramidal signs in both lower extremities, more pronounced in left IE, without clear motor deficit; deep sensitivity was also slightly altered. | |
| Complementary tests helped to clarify the diagnosis: | |
| MRI showed two lesions compatible with myelitis at the cervical C2-C4 and upper dorsal D1 levels. | |
| Evoked potentials showed significant delay in tibial nerve latency. | |
| CSF: mild lymphocytic pleocytosis, increased protein concentration and presence of oligoclonal IgG bands. | |
| Serological tests, ELISA and Western Blot were positive for HTLV-I in CSF and blood. | |
| Positive blood PCR for the virus was also detected in this case, high viral load. | |
| The patient was treated with 6-Methyl-Prednisolone wristbands at the time of exacerbation of the process and progressively descending corticosteroids. | |
| However, in addition to the quadroid habit, the patient presents progressive hearing loss, predominantly nocturnal urinary incontinence, which has improved with Tolterodine (a discrete urodynamic study at the present time). | |