Parkinsonism as the presenting manifestation of HIV infection: Improvement on HAART

Extrapyramidal disorders have been seen in patients with AIDS and AIDS dementia complex (ADC), and parkinsonism has been seen in patients with AIDS exposed to neuroleptics.1-3⇓⇓ There have been no cases reported of parkinsonism and HIV infection without a history of associated AIDS-related complex (ARC),3 neuroleptic exposure,1,2⇓ associated neurologic findings not restricted to the extrapyramidal system,3 ADC,2 or secondary brain infections.1,3⇓ One patient had proven CNS Whipple’s disease,3 in addition to HIV infection found in the biopsy. Many of the cases reported had severe immunosupression with advanced HIV infection.1 We report a patient with pure parkinsonism as the sole manifestation and presenting feature of his HIV infection. Furthermore, we report that his extrapyramidal symptoms resolved within 1 year after starting highly active antiretroviral therapy (HAART). A 37-year-old right-handed man presented with incoordination and shakiness of his right hand, a change in handwriting, and mild balance impairment of 4 months’ duration. He had been well until 6 months earlier when, while traveling in Spain, he had fatigue, headache, and lymphadenopathy, which resolved after 2 to 3 weeks. One month later he experienced a sense of imbalance when descending stairs and veering to one side while walking. Subsequently, he began to notice clumsiness, incoordination, and an irregular tremor when using his …