Hemicoréia-hemibalismo associado a granuloma criptocócico em paciente com SIDA: relato de caso Hemichorea-hemiballism associated to cryptococcal granuloma in AIDS: case report

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.Movement disorders are not common in acquired immunodeficiency syndrome. Hemichorea-hemiballism (HC-HB) is the most common of them all, and it is usually related to oportunistic toxoplasmosis of the basal ganglia. We present a 28-year-old man, HIV positive with HC-HB caused by a right subthalamic granuloma, which did not respond to treatment for toxoplasmosis. Cryptoccococic antigen was positive in the cerebrospinal fluid and antifungic therapy led to clinical and radiologic improvement, thus the diagnosis of a granulomatous lesion by Cryptococcus neoformans was established. Current literature on HC-HB and its relationship with AIDS is subsequently reviewed.

Keywords

• síndrome de imunodeficiência adquirida (SIDA)
• hemicoréia-hemibalismo
• criptococose
• acquired immunodeficiency syndrome (AIDS)
• hemichorea-hemiballism
• cryptococcosis