Chronic HIV Infection Associated With Motor Neuron Disease and Parkinsonism: A Case Report and Narrative Review

Abstract

Motor neuron disease and parkinsonism syndromes associated with chronic HIV infection are extremely rare, with only a few cases reported in major medical databases. We report a case from Brazil involving a patient with a chronic, well-controlled HIV infection for approximately 15 years, demonstrating a good response to highly active antiretroviral therapy. Despite the absence of viral replication, the patient developed atypical clinical and topographical features consistent with both pyramidal and extrapyramidal syndromes. This raises the question of whether such findings could be linked to chronic HIV infection, occurring simultaneously even in the absence of active viral replication, particularly given that other potential diagnoses were excluded.

Keywords: chronic hiv; extrapyramidal syndromes; motor neuron disease (mnd); neurodegeneration; parkinsonism; pyramidal syndromes.

Figure 1. MRI showing a mesencephalic lesion and thinning of the substantia nigra

Figure 2. T1-weighted sequence with magnetization transfer technique showing a subtle hypersignal along the pyramidal pathway (arrows in A and B)

Figure 3. Magnetic susceptibility imaging shows marked hypointensity in the topography of the precentral gyrus cortex, a finding commonly observed in upper MNDs

MND, motor neuron disease