Objective: Our aim was to describe the clinical picture of an HIV patient with a progressive neurodegenerative disorder likely Progressive supranuclear palsy (PSP).

Background: Movement disorders are common manifestations of HIV infection which may precede the diagnosis and improve with antiretroviral therapy. The true incidence of PSP in patients with HIV is unknown.

Methods: Description of a case presentation.

Results: A 76 year old man attended the Movement Disorder clinic with a history of 2 years of progressive gait disturbance, unsteadiness and dizziness. The physical examination revealed limitation in supranuclear vertical gaze, slow saccades, bilateral symmetric bradykinesia and postural tremor of the arms. The gait showed decreased step height, diminished stride length and decreased bilateral arm swing. He hesitated upon turning. He needed 5 steps backwards to regain balance during the pull test. Cerebral sonography showed normal echogenic substantia nigra with marked subcortical atrophy and hyperechogenicity of the lenticular nucleus. Cranial MRI showed mesencefalic atrophy with "hummingbird " or "emperor penguin" morphology. CSF total tau and p-tau are pending. The clinical picture and additional diagnostic tests supported the syndromic diagnosis of atypical parkinsonism, likely PSP. The patient had a chronic HIV infection stage B2 with good inmune control without previous neurological complications.

Conclusions: We presented a case report of HIV patient and parkinsonism. In postmortem studies, it has been found that HIV-positive patients have a lower concentration of dopamine in the basal ganglia, lenticular nucleus and substantia nigra, coinciding with increased virus replication within these areas. The association between HIV infection and parkinsonism could be explained by direct viral damage to the substantia nigra and dopaminergic pathways.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/psp-and-hiv-causality-or-coincidence/