58-year-old male at the time of transplantation on 5 October 1998.
In a peritoneal dialysis program since January of the same year due to progressive CRF secondary to glomerulonephritis type IgA with focal segmental consolidation diagnosed in 1984.
Other relevant backgrounds: arterial hypertension diagnosed in 1982, under pharmacological treatment, ischemic heart disease due to coronary artery disease with transcranial angioplasty of the right coronary artery in 1994 (since then asymptomatic, negative subsequent stress tests), type II dyslipidemia.
Bilateral cryptorchidism and cryptorchidism intervene in youth.
Renal transplantation was uneventful (left kidney in the right iliac fossa with two single patchy arteries and a vein adjoining the external iliac arteries), with an immediate effect on the graft without acute rejection and high clinical toxicity.
The patient was treated with cyclosporine 8mg/Kg, mycophenolate mofetil 2gr/day, and prednisone 1mg/Kg, progressively decreasing the numbers in subsequent controls.
In September 2000 (two years after transplantation), the patient reported for the first time a feeling of instability in walking and tremors in the hands that progressively increased, starting a neurology service study.
At the time of the study, the patient presented gait instability, paresthesias in both lower limbs (LLS) and tremors in hands.
Physical examination showed no motor deficit, but there was a decrease in vibratory sensitivity in both lower extremities, living osteotendinous reflexes (OTT) and cutaneous-plantar reflex (CPR) in extension.
Magnetic resonance imaging (MRI) showed no brain or spinal lesions. Cerebrospinal fluid analysis (CSF) showed lymphocytic pleocytosis without oligoclonal bands and HTLV-positive Tibial chain reaction in HTLV-positive cases.
A high viral load was demonstrated.
The patient was diagnosed with tropical spastic paraparesis (TSP), and despite repeated pulses of 6-Methyl-Prednisolone, progresses progressively.
Treatment with Interferon has been rejected due to the possibility of transplant rejection. From the point of view of renal function, it has remained correct at all times with creatinine levels ranging from 1-1-2.
It has been studied by our Service due to an emergency situation with leaks and occasional gouts.
A radiological and urodynamic study confirmed the existence of bladder hyperlexic bladder calculi and a large bladder stone that was extracted by cystolithotomy without postoperative complications in December 2003.
At this time the patient is dependent for basic functions of daily life such as cleanliness, walking (displacement in wheels), feeding (not able to support a spoon)
