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Human T-cell leukemia virus (HTLV-1), a human retrovirus, is transmitted by breastfeeding, sexual contact, blood transfusion, and contaminated needles. Most patients are asymptomatic, but after a variable latent period (which may be as long as several years), a myelopathy develops in some instances. The MRI, electrophysiologic, and cerebrospinal fluid findings are similar to those of multiple sclerosis, but HTLV-1 antibodies are present in serum and spinal fluid. There is no specific treatment, but intravenous or oral corticosteroids may help in the initial inflammatory phase of the disease. Prophylactic measures are important. Needles or syringes should not be shared; infected patients should not breastfeed their infants or donate blood, semen, or other tissue. Infected patients should use condoms to prevent sexual transmission.