Hemicoréia-hemibalismo associado a granuloma criptocócico em paciente com SIDA: relato de caso

Abstract

Distúrbios do movimento são pouco frequentes na síndrome de imunodeficiência adquirida (SIDA). Dentre eles destaca-se a hemicoréia-hemibalismo (HC-HB), relacionada a infecção oportunística pelo Toxoplasma gondii. Relatamos caso de HC-HB em um paciente de 28 anos portador de SIDA associada a lesão granulomatosa no núcleo sub-talâmico direito. Após insucesso no tratamento para neurotoxoplasmose, com a pesquisa de antígeno criptocóccico positiva no líquor, houve melhora clínica e radiológica com terapia antifúngica, estabelecendo-se o diagnóstico etiológico de granuloma por Cryptococcus neoformans. Discorre-se acerca das causas de HC-HB, com menção especial ao diagnóstico diferencial deste distúrbio em indivíduos infectados pelo HIV.

Treatable Hyperkinetic Movement Disorders Not to Be Missed

“…Cerebral fungal infection should be considered in immunodeficient patients presenting with abnormal hyperkinetic movements. Hemichorea-hemiballismus and choreoathetosis have been reported to be associated with cryptococcosis [cryptococcal granuloma located in the subthalamic nucleus ( 47 ) or cryptococcal meningitis ( 48 , 49 )], or cerebral histoplasmosis ( 50 ) in HIV infected patients. Cases of hemidystonia or chorea were described in association with cysticercosis cysts or calcifications in the thalamus or putamen.…”

Teaching Video NeuroImage: Subacute Hemichorea Secondary to Disseminated Cryptococcus Infection in an Immunocompetent Host

“…Cryptococcal infections occasionally present as neurocryptococcosis but rarely as hemichorea, especially in immunocompetent hosts. 1,2 After induction therapy with IV amphotericin B plus flucytosine followed by voriconazole, hemichorea (Video 1) and neuroimaging (Figure) improved significantly.…”