Objective: –

Background: HIV infection of the central nervous system can be a result of direct neuroinflammatory processes or by opportunistic infections. Movement disorders in HIV infection are not uncommon as it has a predilection for subcortical structures, however, acute parkinsonism as a primary manifestation of fulminant HIV encephalopathy has been rarely reported.

Method: Case Report

Results: A 32 year old gentleman with recent diagnosis of retroviral disease not on highly active antiretroviral therapy, presented with one month history of altered mentation associated with marked hypomimia, symmetrical akinetic rigid syndrome and paucity of tremor. There was no drug history of antiemetics or neuroleptics prior to presentation. MRI Brain showed abnormal hyperintensities in bilateral basal ganglia, middle temporal lobes and brainstem. CSF analysis was acellular with high protein but normal glucose ratio. Screening for opportunistic infections including hepatitis B, hepatitis C, toxoplasma, cryptococcal, EBV and CMV were all negative. His CD4 cell count was 9 cells/µL.
He showed mild improvement with levodopa therapy during initial phase. A judicious decision for early commencement of antiretroviral therapy within 2 weeks was made after exclusion of opportunistic infections. After 3 months, he showed remarkable resolution of parkinsonism concordant with MRI findings.

Conclusion: Fulminant HIV encephalopathy in AIDS carries high mortality. We highlight the importance of early commencement of antiretroviral treatment in our case to reverse the disease course.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-rare-case-of-reversible-acute-parkinsonism-in-fulminant-hiv-encephalopathy/