Neuropsychiatric Symptoms in Cerebral Toxoplasmosis with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS): Case Report

Abstract

Cerebral toxoplasmosis is often caused by the reactivation of pre-existing infections. The increasing number of HIV/AIDS increased cases of cerebral toxoplasmosis. Cerebral toxoplasmosis can show clinical symptoms of neurological and psychiatric. Psychiatric symptoms such as psychosis are often associated with cerebral toxoplasmosis infection. Hemichorea and hemiballism are movement disorders often found in cerebral toxoplasmosis, although movement disorders are less common than other neurological symptoms. We report that a 53-year-old man with complaints of whole-body weakness three days before admitted to the hospital. Patient's appetite decreased. While being treated, he saw an oriental figure walking back and forth as if watching him. Patient also heard voices and complained involuntary movements in the right hand and leg. Neurological examination revealed right hemichorea with characteristics; arrhythmic, irregular, high amplitude, and improved at rest. Psychiatric examination revealed visual and auditory hallucinations. Laboratory examination showed anemia and leukopenia. Chest X-ray revealed a left pleural effusion. Magnetic Resonance Imaging (MRI) of the head with contrast showed multiple lesions with perifocal edema, suspected cerebral toxoplasmosis. Patient received anti-toxoplasmosis and antipsychotic. Patient improved on the sixth day of treatment. Cerebral toxoplasmosis can cause serious complications in patients with HIV/AIDS. Psychotic symptoms such as hallucinations and delusions are often associated with cerebral toxoplasmosis infection. Hemichorea is the most common type of movement disorder in toxoplasmosis cerebral patients related to HIV/AIDS. The main treatment is anti-toxoplasmosis medication. Combination with antipsychotics is effective in treating the symptoms of psychosis and hemichorea, while also inhibiting the replication of Toxoplasma gondii. Keywords: Cerebral Toxoplasmosis, HIV/AIDS, Neuropsychiatric