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CC BY 4.0 · Arq Neuropsiquiatr 2023; 81(09): 857-858
DOI: 10.1055/s-0043-1771170
Images in Neurology

Chorea secondary to human immunodeficiency virus infection

Coreia secundária à infecção pelo vírus da imunodeficiência humana
André Eduardo de Almeida Franzoi 
1   Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Serviço de Neurologia, Curitiba PR, Brazil.
,
Amanda Maieski 
1   Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Serviço de Neurologia, Curitiba PR, Brazil.
,
Caio César Diniz Disserol 
1   Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Serviço de Neurologia, Curitiba PR, Brazil.
,
Helio Afonso Ghizoni Teive 
1   Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Medicina Interna, Serviço de Neurologia, Curitiba PR, Brazil.
2   Universidade Federal do Paraná, Hospital de Clínicas, Setor de Distúrbios do Movimento, Curitiba PR, Brazil.
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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]

Video 1 Patient with chorea before treatment for HIV and without chorea after treatment with antiviral therapy.


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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.

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Conflict of Interest

The authors have no conflict of interest to declare.

Authors' Contributions

AEAF: conceptualization, data curation, formal analysis, investigation, validation, writing – original draft; AM: investigation, writing – original draft; CCDD, HAGT: investigation, supervision. All authors read and approved the final manuscript.


Support

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



Address for correspondence

André Eduardo de Almeida Franzoi

Publication History

Received: 11 December 2022

Accepted: 15 March 2023

Article published online:
04 October 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Zoom Image
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.