Case report: 29-year-old male with Hemichorea-hemiballismus as the initial manifestation caused by cerebral Toxoplasmosis with diagnostic of HIV without treatment


  • Juan Carlos López-Hernández Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez
  • Arturo Violante Villanueva
  • Lilia Salas Alvarado
  • Xiomara Garcia


Hemiballismus, Hemichorea, Toxoplasmosis, HIV


Background: The hemichorea and hemiballismus are movement disorder rare related to toxoplasmosis gondii infection in patients with HIV.

Objective: Describe the case of a male patient know as HIV positive without antiretroviral treatment with first manifestation was right side hemichorea-hemiballism.

Material and Methods: Case report.

Results: 29-year-old male known to have HIV for 4 years, without antiretroviral treatment. He went to the emergency room presenting involuntary movements in the right side of his body that sedate when sleeping. On neurological examination appear to be normal; only with the presence of abnormal movements characterized by non-rhythmic, large-amplitude, violent and sometimes choreiform movements in the right side of the body. In a brain MRI study in T1 sequence with contrast, he presented a lesion that captures contrast medium in the form of a closed ring at the level of the left basal nucleus. He receives treatment for toxoplasmosis with trimethoprim-sulfamethoxazole and pyrimethamine- clindamycin. The hemichorea- hemiballism was treated with haloperidol, aripiprazole, clonazepam, having clinical and radiological improvement.

Conclusion: The hemichorea- hemiballism is a neurological manifestation unfrequently related to toxoplasmosis HIV positive. Treatment for toxoplasmosis, movement disorder, and antiretroviral therapy should be started promptly.


Bowen LN, Smith B, Reich D, Quezado M, Nath A. HIV-associated opportunistic CNS infections: Pathophysiology, diagnosis and treatment. Nat Rev Neurol. 2016;12(11):662–74.

Patel AR, Patel AR, Desai S. Acute Hemiballismus as the Presenting Feature of Parietal Lobe Infarction. Cureus. 2019;11(5).

Dimal NPM, Santos NJC, Reyes NGD, Astejada MN, Jamora RDG. Hemichorea-hemiballismus as a presentation of cerebritis from intracranial toxoplasmosis and tuberculosis. Tremor and Other Hyperkinetic Movements. 2021;11(1):1–11.

Mattos JP, de Rosso AL, Corrêa RB, Novis S. Hemicorea asociada a toxoplasmosis cerebral y SIDA. Arq Neuropsiquiatr. 1995;53(3 A):534.

Postuma RB, Lang AE. 2003-Hemiballismus review. 2003;2:661–8.

Navia BA, Petito CK, Gold JWM, Cho E ‐S, Jordan BD, Price RW. Cerebral toxoplasmosis complicating the acquired immune deficiency syndrome: Clinical and neuropathological findings in 27 patients. Ann Neurol. 1986;19(3):224–38.

Kim JS. Case report: Case report. Can Fam Physician. 2001;47(10):788–9.

Tse W, Cersosimo MG, Gracies JM, Morgello S, Olanow CW, Koller W. Movement disorders and AIDS: A review. Park Relat Disord. 2004; 10(6): 323–34.

Marcus C, Feizi P, Hogg J, Summerfield H, Castellani R, Sriwastava S, et al. Imaging in differentiating cerebral toxoplasmosis and primary CNS lymphoma with special focus on FDG PET/CT. Am J Roentgenol. 2021;216(1):157–64.

Safarpour H, Cevik M, Zarean M, Barac A, Hatam-Nahavandi K, Rahimi MT, et al. Global status of Toxoplasma gondii infection and associated risk factors in people living with HIV. Aids. 2020;34(3):469–74.

Schlüter D, Barragan A. Advances and challenges in understanding cerebral toxoplasmosis. Front Immunol. 2019;10:1–13.

Vidal JE. HIV-Related Cerebral Toxoplasmosis Revisited: Current Concepts and Controversies of an Old Disease. J Int Assoc Provid AIDS Care. 2019;18:1–20.

Hernandez A V., Thota P, Pellegrino D, Pasupuleti V, Benites-Zapata VA, Deshpande A, et al. A systematic review and meta-analysis of the relative efficacy and safety of treatment regimens for HIV-associated cerebral toxoplasmosis: is trimethoprim-sulfamethoxazole a real option? HIV Med. 2017;18(2):115–24.

Hosoda T, Mikita K, Ito M, Nagasaki H, Sakamoto M. Cerebral toxoplasmosis with multiple hemorrhage lesions in an HIV infected patient: A case report and literature review. Parasitol Int. 2021;81(November 2020):102280.

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López-Hernández, J. C., Violante Villanueva, A., Salas Alvarado, L., & Garcia, X. (2023). Case report: 29-year-old male with Hemichorea-hemiballismus as the initial manifestation caused by cerebral Toxoplasmosis with diagnostic of HIV without treatment. Archivos De Neurociencias, 1(Inpress). Retrieved from



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