Hemichorea-Hemiballismus As Presentation of Toxoplasma gondii Encephalitis in an Immunocompromised Host

Toxoplasma gondii encephalitis is a common but serious opportunistic infection in people living with human immunodeficiency virus (PLHIV), particularly those with advanced disease and low CD4 counts. Its classical manifestations include fever, altered mental status, seizures and focal neurological signs. Movement disorders are a less common consequence, with hemichorea-hemiballismus (HCHB) representing a rare but striking manifestation. We describe a 36-year-old man with advanced HIV disease who had defaulted on treatment. He presented with bizarre, involuntary movements of his left upper and lower limbs. His serum Toxoplasma IgG was positive, and brain imaging revealed a basal ganglia lesion leading to the presumptive diagnosis of cerebral toxoplasmosis. He was treated with anti-toxoplasmosis and anti-dyskinetic medications, achieving both clinical and radiological resolution after one month of therapy. A high clinical suspicion for Toxoplasma gondii encephalitis should be maintained in patients with advanced HIV disease who present with rare manifestations such as movement disorders. Timely management, guided by serology and brain imaging, is essential to improve treatment outcomes.