Chorea associated with persistent low-level viremia in a patient living with HIV: a case report

Rajakaruna, Gayathri K.; Italiano, Claire M.; John, Mina; Nolan, David

doi:10.1016/s2055-6640(20)30007-8

Cited by 4 publications

(3 citation statements)

References 12 publications

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“…Typically, chorea or tremor are observed in patients with cognitive deterioration in the context of HIV encephalopathy or AIDS-dementia complex (35,39,40). Similar movement disorders can also be observed in patients with HIV CNS viral escape, who have an independent replication of HIV RNA in the central nervous system (despite a well-controlled plasma HIV infection), due to selective resistance to the treatment of the virus present in the CSF compartment (34,41). Initiation or optimization of highly active antiretroviral therapies combinations, favoring drugs with good CNS penetration, is usually an effective treatment of movement disorders in this setting (34,35,(41)(42)(43)(44).…”

Section: Hyperkinetic Movement Disorders Due To Viral Infection Of the Basal Gangliamentioning

confidence: 99%

Treatable Hyperkinetic Movement Disorders Not to Be Missed

et al. 2021

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Hyperkinetic movement disorders are characterized by the presence of abnormal involuntary movements, comprising most notably dystonia, chorea, myoclonus, and tremor. Possible causes are numerous, including autoimmune disorders, infections of the central nervous system, metabolic disturbances, genetic diseases, drug-related causes and functional disorders, making the diagnostic process difficult for clinicians. Some diagnoses may be delayed without serious consequences, but diagnosis delays may prove detrimental in treatable disorders, ranging from functional disabilities, as in dopa-responsive dystonia, to death, as in Whipple's disease. In this review, we focus on treatable disorders that may present with prominent hyperkinetic movement disorders.

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Section: Hyperkinetic Movement Disorders Due To Viral Infection Of the Basal Gangliamentioning

confidence: 99%

Treatable Hyperkinetic Movement Disorders Not to Be Missed

et al. 2021

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“…HIV encephalopathy [84]; viral encephalitis (mumps, measles, varicella-zoster virus, herpes simplex virus, ECHO group viruses); new variant of Creutzfeldt-Jakob disease; diphtheria; bacterial endocarditis; neurobrucellosis; neurosyphilis; neuroborreliosis; other bacterial encephalitides; cerebral toxoplasmosis; CNS cryptococcosis; neurocysticercosis [14]; Whipple's disease (including ataxia, vertical gaze palsy, oculomasticatory myorhythmias, cognitive impairment [79]); subacute sclerosing panencephalitis (SSPE [98]); Influenza A encephalopathy [81]; SARS-CoV-2 encephalitis [42].…”

Section: Infectious Causesmentioning

confidence: 99%

Differential diagnosis of chorea (guidelines of the German Neurological Society)

Saft,

Burgunder,

Dose

et al. 2023

Neurol. Res. Pract.

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Introduction Choreiform movement disorders are characterized by involuntary, rapid, irregular, and unpredictable movements of the limbs, face, neck, and trunk. These movements often initially go unnoticed by the affected individuals and may blend together with seemingly intended, random motions. Choreiform movements can occur both at rest and during voluntary movements. They typically increase in intensity with stress and physical activity and essentially cease during deep sleep stages. In particularly in advanced stages of Huntington disease (HD), choreiform hyperkinesia occurs alongside with dystonic postures of the limbs or trunk before they typically decrease in intensity. Summary or definition of the topic The differential diagnosis of HD can be complex. Here, the authors aim to provide guidance for the diagnostic process. This guidance was prepared for the German Neurological Society (DGN) for German-speaking countries. Recommendations Hereditary (inherited) and non-hereditary (non-inherited) forms of chorea can be distinguished. Therefore, the family history is crucial. However, even in conditions with autosomal-dominant transmission such as HD, unremarkable family histories do not necessarily rule out a hereditary form (e.g., in cases of early deceased or unknown parents, uncertainties in familial relationships, as well as in offspring of parents with CAG repeats in the expandable range (27–35 CAG repeats) which may display expansions into the pathogenic range). Conclusions The differential diagnosis of chorea can be challenging. This guidance prepared for the German Neurological Society (DGN) reflects the state of the art as of 2023.

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“…Hemiballism-hemichorea and tremor were reported as the most common hyperkinetic movement disorders in HIV, with 3% of all patients with HIV infection and 50% of patients with AIDS developing clinically relevant movement disorders [30]. Additionally, case reports have described hemichorea and choreoathetosis in patients with HIV, even as initial symptoms in patients with persisting low-level viremia [31][32][33]. A recent case series described eight patients suffering from HIV and HD, who had a nine year earlier disease onset of HD compared to other motor-manifest HD patients, potentially caused by a neurobiological link between the two diseases [34].…”

Section: Introductionmentioning

confidence: 99%

Differential Diagnosis of Chorea—HIV Infection Delays Diagnosis of Huntington’s Disease by Years

2021

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Background: There is a broad range of potential differential diagnoses for chorea. Besides rare, inherited neurodegenerative diseases such as Huntington’s disease (HD) chorea can accompany basal ganglia disorders due to vasculitis or infections, e.g., with the human immunodeficiency virus (HIV). The clinical picture is complicated by the rare occurrence of HIV infection and HD. Methods: First, we present a case suffering simultaneously from HIV and HD (HIV/HD) focusing on clinical manifestation and disease onset. We investigated cross-sectional data regarding molecular genetic, motoric, cognitive, functional, and psychiatric disease manifestation of HIV/HD in comparison to motor-manifest HD patients without HIV infection (nonHIV/HD) in the largest cohort of HD patients worldwide using the registry study ENROLL-HD. Data were analyzed using ANCOVA analyses controlling for covariates of age and CAG repeat length between groups in IBM SPSS Statistics V.25. Results: The HD diagnosis in our case report was delayed by approximately nine years due to the false assumption that the HIV infection might have been the cause of chorea. Out of n = 21,116 participants in ENROLL-HD, we identified n = 10,125 motor-manifest HD patients. n = 23 male participants were classified as suffering from HIV infection as a comorbidity, compared to n = 4898 male non-HIV/HD patients. Except for age, with HIV/HD being significantly younger (p < 0.050), we observed no group differences regarding sociodemographic, genetic, educational, motoric, functional, and cognitive parameters. Male HIV/HD patients reported about a 5.3-year-earlier onset of HD symptoms noticed by themselves compared to non-HIV/HD (p < 0.050). Moreover, patients in the HIV/HD group had a longer diagnostic delay of 1.8 years between onset of symptoms and HD diagnosis and a longer time regarding assessment of first symptoms by the rater and judgement of the patient (all p < 0.050). Unexpectedly, HIV/HD patients showed less irritability in the Hospital Anxiety and Depression Scale (all p < 0.05). Conclusions: The HD diagnosis in HIV-infected male patients is secured with a diagnostic delay between first symptoms noticed by the patient and final diagnosis. Treating physicians therefore should be sensitized to think of potential alternative diagnoses in HIV-infected patients also afflicted by movement disorders, especially if there is evidence of subcortical atrophy and a history of hyperkinesia, even without a clear HD-family history. Those patients should be transferred for early genetic testing to avoid further unnecessary diagnostics and improve sociomedical care.

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Chorea associated with persistent low-level viremia in a patient living with HIV: a case report

Cited by 4 publications

References 12 publications

Treatable Hyperkinetic Movement Disorders Not to Be Missed

Treatable Hyperkinetic Movement Disorders Not to Be Missed

Differential diagnosis of chorea (guidelines of the German Neurological Society)

Differential Diagnosis of Chorea—HIV Infection Delays Diagnosis of Huntington’s Disease by Years

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