81 Letter to the Editor / Editöre Mektup DOI:10.4274/tnd.94758 Turk J Neurol 2017;23:81-83 A Case of Neuro-AIDS Presenting with Rapidly Progressive Dementia and Parkinsonism with Rapid Response to Treatment Demans ve Parkinsonizm Tablosu ile Başvuran ve Tedaviye Hızlı Yanıt Veren Bir Nöro-AIDS Olgusu Yasemin Akıncı 1 , Melis Sohtaoğlu Sevindik 2 , Bilgül Mete 3 , Umran Şumeyse Ertürk 3 , Mehmet Yürüyen 4 , Bekir Sami Kocazeybek 5 , Melda Bozluolcay 1 1 Istanbul University Cerrahpaşa Faculty of Medicine, Department of Neurology, Istanbul, Turkey 2 Helios Clinic, Clinic of Neurology, Hattingen, Germany 3 Istanbul University Cerrahpaşa Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey 4 Istanbul University Cerrahpaşa Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Istanbul, Turkey 5 Istanbul University Cerrahpaşa Faculty of Medicine, Department of Microbiology and Clinical Microbiology, Istanbul, Turkey Keywords: HIV, AIDS, dementia, parkinsonism, combination antiretroviral therapy Anahtar Kelimeler: HIV, AIDS, demans, parkinsonizm, kombine antiretroviral tedavi Dear Editor, Cognitive impairment associated with Acquired Immune Deficiency Syndrome (AIDS) by the direct effect of the virus, as well as by opportunistic diseases in the brain, has shown significant changes with the use of combined antiretroviral therapy. Although the brain functions as a “Human Immunodeficiency Virus (HIV)” reserve in spite of treatment, and chronic inflammation and cognitive impairment due to neurotoxic effects of antiretroviral agents can persist in 5-10% of the patients, the incidence of HIV- related dementia, which is the most severe form of infection- related cognitive impairment, is reported to be reduced by about 50% in the post-treatment period (1,2,3,4). We would like to emphasize the importance of early and accurate diagnosis by presenting a patient with HIV-associated neurocognitive disorder (HAND) who was also diagnosed as having Toxoplasma encephalitis, with dementia and parkinsonism and had a rapid response to treatment. A man aged 54 years presented with symptoms of general malaise, anorexia, weight loss, behavioral change, forgetfulness, and unbalanced and slow walking. He was diagnosed as having primary pulmonary tuberculosis infection one year ago. Symptoms of weakness, fever, and loss of balance did not improve despite the tuberculosis treatment under regular follow-up for six months, and loss of balance worsened within 2 months of the treatment being terminated and symptoms of slowly progressive disorientation, confusion attacks, forgetfulness, anger attacks, and aggression started. He became fully dependent for daily activities during the last three months. Due to stagnation and the subsequent sudden anger attacks,that have recently become evident, he was admitted to the emergency service. The patient had a history of chronic obstructive pulmonary disease, benign prostatic hyperplasia, and 30 packet-years of smoking. The patient had a cachectic appearance and had herpetic rashes that persisted around his mouth for several months. On neurologic examination, he was apathetic, limited cooperation and impaired orientation to person, place, and time. The fluency of speaking was impaired, and the latency of the response to questions was extended. Bilateral bradykinesia and slow walking in the forefront posture were remarkable. His postural reflexes were impaired, Romberg test was positive, and the tandem walk was incompetent. Address for Correspondence/Yaz›flma Adresi: Yasemin Akıncı MD, Istanbul University Cerrahpaşa Faculty of Medicine, Department of Neurology, Istanbul, Turkey Phone: +90 505 998 50 70 E-mail: yasemnaknc@gmail.com Received/Gelifl Tarihi: 25.07.2016 Accepted/Kabul Tarihi: 09.12.2016 © Copyright 2017 by Turkish Neurological Society Turkish Journal of Neurology published by Galenos Publishing House.