Stage C neuro-HIV revealed by head tremor: a case study with review of the literature

Abstract

The neurological manifestations of HIV infection are very numerous and varied. In 2018, in Morocco, 30% of seropositive subjects are unaware of their infection. Our patient was one of them. Observation: Authors report the case of a 28-year-old woman, widowed at the age of 20 after a traffic accident. In 2009, she moved to Senegal with the onset of chronic consumption of tobacco and alcohol and unprotected sexual relations with multiple partners. The patient was admitted to our training for an insidious symptomatology going back a year, marked by tremor of the head, improved by the alcohol intake, in a context of weight loss not quantified. The examination objectified a statokinetic cerebellar syndrome. Brain magnetic resonance imaging (MRI) did not show any atrophy or cerebellar damage. The main diagnoses discussed were: sequelae of viral cerebellitis, neurological complications of alcohol intoxication and essential tremor. The complete blood count demonstrated lymphopenia at 660 µL. The HIV and CMV serologies came back positive. Universal meningeal PCR returned VZV. The diagnosis of cerebellar VZV on AIDS was retained. The patient was initially put on Ganciclovir with marked regression of the tremors then on triple therapy after announcement of the diagnosis. Conclusion: The VZV is the 2nd cause of viral cerebrellitis after the West Nile virus. It can be seen in both the immunocompetent and the immunocompromised. The absence of a concomitant rash is not an exclusion criterion. However, its presence makes diagnostic suspicion easier.
 Keywords: head tremor, cerebellitis, HIV, VZV, alcohol, essential tremor.