Objective: To describe a patient with unusual and rare initial presentation of HIV infection – a progressive cerebellar ataxia.

Background: Isolated cerebellar degeneration in an HIV patient is rare and should prompt a diagnostic work up. Cerebellar complications of HIV infection primarily manifested in ataxia, usually arise as the result of cerebellar lesions due to opportunistic infections, vasculitis or neoplastic.  

Methods: Case Report

Results: A 44-year-old woman, without comorbidities, developed a progressive imbalance and gait ataxia 6 months ago. At this time behavior disorders was detected and she was treated with psychiatry, using quetiapine, fluoxetine and amitriptyline. The neurological examination showed preserved cognition, slowing saccadic eye movements, dysmetria, dysdiadochokinesia, and gait ataxia. Brain MRI was normal and abdominal ultrasound demonstrated splenomegaly. Extensive work-up was negative. In the follow-up this patient developed oropharynx whitened lesions, dysphagia and worsening gait. Serology HIV test was positive and a brain MRI showed cerebellar atrophy. CSF exam showed hyperproteinorrachia of 51.9 mg. Viral HIV load was 24880 and CD4 count of 65. The patient starts the treatment with HAART, buspirone and sulphametoxazole-trimethoprim prophylactic.

Conclusions: HIV infection should be considered as an etiology in clinical setting of subacute cerebellar ataxia, particularly in a young or immunocompromised patient.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/cerebellar-ataxia-the-first-symptom-of-hiv-infection/