P151 – 2899: Cerebral toxoplasmosis presenting with chorea in a totally immunocompetent patient

Objective Chorea is a common movement disorder which can be caused by a variety of diseases including neurodegenerative diseases, metabolic diseases, infectious diseases and autoimmune diseases, or can be secondary to structural changes. Cerebral Toxoplasmosis is a rare cause of choreiform movement disorders and is seen often in AIDS patients. Methods Herein, we present a chorea case with central nervous system toxoplasmosis. Results 11 year-old girl patient was presented with involuntary movements in her hands and difficulty in speaking in the last month. Neurological examination revealed milkmaid sign and pronation sign of the hands. Choreiform movements of hands, legs and body were seen. She was having trouble with standing balanced, wearing her clothes on and she was speaking quite slow and lisping. Haloperidol was given but none of these findings got better. In the meantime, laboratory tests for finding an etiological cause (throat culture, ASO, echocardiography, cranial magnetic resonance imaging) failed to demonstrate any pathology. However, examination of cerebro-spinal fluid showed toxoplasma positivity in PCR. Anti-HIV and HIV-RNA were negative. Immunoglobulin levels, immunoglobulin subclasses, lymphocyte subgroups, and complement activity were examined and no disorders were detected. After administration of anti-toxoplasmotic agents (Pyrimethamine, Sulfadiazine and Leucovorin) all symptoms and signs vanished. Conclusion Choreiform movement disorder secondary to cerebral toxoplasmosis is usually seen in HIV positive patients. To the best of our knowledge, this one is the very first case with central nervous system toxoplasmosis in a patient who doesn't have any kind of immunodeficiency.