Chorea secondary to human immunodeficiency virus infection

Coreia secundária à infecção pelo vírus da imunodeficiência humana

A 55-year-old woman presented with facial and cervical chorea for 3 months (video). She had a previous history of traumatic right facial nerve palsy but no comorbidities or current medication use. Brain magnetic resonance imaging (MRI) was performed (Figure 1). Cerebrospinal fluid analysis was unremarkable. Serum tests were positive for human immunodeficiency virus (HIV) type 1 with 1.877.056 viral copies and T-CD4 lymphocyte count of 35/mm³. Darunavir, ritonavir, dolutegravir, and lamivudine were initiated. After 4 months, chorea showed resolution (Video 1). Chorea is a rare manifestation of HIV infection.¹,² Differential diagnoses like neurosyphilis, Huntington disease, and Wilson disease should be ruled out.²

Figure 1
(A) Magnetic resonance imaging with axial T2/FLAIR sequence shows nonspecific hyperintensities in the white matter. (B) Coronal T2-weighted sequence shows brain volumetric reduction predominantly on the left parieto-occipital region, hyperintensities in the white matter, and moderate dilatation of supratentorial ventricular system with prominence of the cerebral sulci and basal cisterns.

Video 1
Patient with chorea before treatment for HIV and without chorea after treatment with antiviral therapy. Online content including video sequences viewable at: https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0043-1771170.

• Support
  The authors did not receive support from any organization for the submitted work.

References

• ¹ Cardoso F. HIV-related movement disorders: epidemiology, pathogenesis and management. CNS Drugs 2002;16(10):663–668. Doi: 10.2165/00023210-200216100-00002
  » https://doi.org/10.2165/00023210-200216100-00002
• ² Rajan S, Kaas B, Moukheiber E. Movement Disorders Emergencies. Semin Neurol 2019;39(01):125–136. Doi: 10.1055/s-0038-1677050
  » https://doi.org/10.1055/s-0038-1677050

Publication Dates

• Publication in this collection
  27 Oct 2023
• Date of issue
  2023

History

• Received
  11 Dec 2022
• Reviewed
  03 Mar 2023
• Accepted
  15 Mar 2023