Hemichorea-hemiballismus as an initial manifestation in a Moroccan patient with acquired immunodeficiency syndrome and toxoplasma infection: a case report and review of the literature

Neurologic signs and symptoms may represent the initial presentation of AIDS in 10-30% of patients. Movement disorders may be the result of direct central nervous system infection by human immunodeficiency virus (HIV) or the result of opportunistic infections. We report the case of a 59 years old woman who had hemichorea-hemiballismus subsequently found to be secondary to a cerebral toxoplasmosis infection revealing HIV infection. Movement disorders, headache and nausea were resolved after two weeks of antitoxoplasmic treatment. Brain MRI control showed a marked resolution of cerebral lesion. Occurrence of hemichorea-ballismus in patient without familial history of movement disorders suggests a diagnosis of AIDS and in particular the diagnosis of secondary cerebral toxoplasmosis. Early recognition is important since it is a treatable entity

Purpura vasculaire, hémorragie alvéolaire : Penser aux effets secondaires du Rituximab

Résumé : Le Rituximab est un anticorps monoclonal anti-CD20 indiqué dans les lymphomes non hodgkiniens, la leucémie lymphoïde chronique et la polyarthrite rhumatoïde réfractaire, mais aussi largement utilisé dans les maladies auto-immunes ; il a changé le pronostic et l’évolution de ces maladies, aux dépens d’effets secondaires, parfois graves. Nous rapportons à travers cette observation, le cas d’une patiente suivie pour un syndrome des anti-synthétases réfractaire, et qui a développé un purpura vasculaire associée à une hémorragie alvéolaire après la perfusion de Rituximab, avec une bonne évolution clinique et radiologique après arrêt du traitement et sous corticothérapie. Summary : Rituximab is an anti-CD20 monoclonal antibody indicated in non-Hodgkin’s lymphoma, chronic lymphocytic leukaemia and refractory rheumatoid arthritis, but also widely used in auto-immunes; it has changed the prognosis and evolution of these diseases, at the expense of side effects, sometimes serious. We report through this observation, the case of a patient followed for a refractory anti-synthetase syndrome and who developed vascular purpura associated with alveolar haemorrhage after infusion of Rituximab, with good clinical and radiological progress after discontinuation of treatment and corticosteroid therapy