Case report: 29-year-old male with Hemichorea-hemiballismus as the initial manifestation caused by cerebral Toxoplasmosis with diagnostic of HIV without treatment

Abstract

Background: The hemichorea and hemiballismus are movement disorder rare related to toxoplasmosis gondii infection in patients with HIV. Objective: Describe the case of a male patient know as HIV positive without antiretroviral treatment with first manifestation was right side hemichorea-hemiballism. Material and Methods: Case report. Results: 29-year-old male known to have HIV for 4 years, without antiretroviral treatment. He went to the emergency room presenting involuntary movements in the right side of his body that sedate when sleeping. On neurological examination appear to be normal; only with the presence of abnormal movements characterized by non-rhythmic, large-amplitude, violent and sometimes choreiform movements in the right side of the body. In a brain MRI study in T1 sequence with contrast, he presented a lesion that captures contrast medium in the form of a closed ring at the level of the left basal nucleus. He receives treatment for toxoplasmosis with trimethoprim-sulfamethoxazole and pyrimethamine- clindamycin. The hemichorea- hemiballism was treated with haloperidol, aripiprazole, clonazepam, having clinical and radiological improvement. Conclusion: The hemichorea- hemiballism is a neurological manifestation unfrequently related to toxoplasmosis HIV positive. Treatment for toxoplasmosis, movement disorder, and antiretroviral therapy should be started promptly.