Objective: To describe the complications of HIV that can present with clinical features of Huntington’s Disease.

Background: The most common forms of hyperkinetic movements in HIV-infected patients are hemichorea and hemiballismus caused by CNS lesions of opportunistic infections like toxoplasmosis, damaging the contralateral basal ganglia connections. These manifestations usually appear in the late stages of the disease. However, we present a case of a patient with cognitive impairment, depressive symptoms, and generalized chorea without other symptoms of immunosuppression.

Methods: Case report.

Results: A 53-year-old female, presented with progressive symmetric involuntary movements involving the head and extremities, distal more than proximal, of 14 months’ duration. The patient also had memory impairment, the speech and activities were slow. The patient was a painter and had a history of alcoholism for 10 years. She was divorced for 8 years, after the divorce, she had 3 sexual partners, family history otherwise unremarkable. Clinical examination revealed generalized chorea and dystonic component in the right upper limb, slow ocular pursuit, lack of attention and concentration, disorientation to place and time and memory loss (MMSE 23/30), a slow, broad-based gait, reflexes were diminished (1/4) without Babinski sign. Hematological tests revealed an iron-deficiency anemia, the thyroid profile was normal. MRI of the brain revealed cerebral atrophy and symmetric periventricular and deep white matter T2 hyperintensity without mass effect. Genetic testing for Huntington’s Disease was negative. Serology for HIV type 1 infection was positive, the CD4 count was 334 cells/mm3. The patient quit alcohol consumption and was started on risperidone and antiretroviral treatment (HAART). After 3 months she showed improvement in her involuntary movements and the gait was better.

Conclusions: HIV infection should be considered in all types of unexplained movement disorders even in patients without non-neurological symptoms of the disease.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/hiv-encephalopathy-mimicking-huntingtons-disease/