Late-Onset Huntington’s Disease: A Rarely Recognized Cause of Chorea in an African Patient

Abstract

Introduction: Huntington’s disease (HD) is a rare autosomal dominant neurodegenerative disorder caused by an expanded CAG repeat in the HTT gene, leading to progressive motor, cognitive, and psychiatric decline. Although well described globally, HD remains underreported in sub-Saharan Africa, where limited awareness and genetic testing contribute to delayed diagnosis and management. The hereditary nature of the condition also presents ethical and psychosocial challenges. This case report highlights the clinical presentation, diagnostic process, and management challenges of Huntington’s disease in an African context.   Case Presentation: A 67-year-old female with a 4-year history of hypertension and type II diabetes mellitus controlled on medication presented with progressive involuntary movements and cognitive decline of three years duration. She developed involuntary, non-patterned rhythmic movements, initially involving the left upper limb, later spreading to other limbs with facial grimacing. There were no identifiable aggravating or relieving factors. Over time, she developed reduced speech output, excessive daytime sleepiness, and occasional urinary and faecal incontinence during sleep. She also experienced intermittent falls at home. There was no history of labile affect, hallucinations, seizures, headache, visual disturbances, dysphagia, or weight loss. Her appetite remained good, but she has been increasingly forgetful. Patient had no exposure to heavy metals, no prior history of stroke, and no known family history of similar presentation. The patient’s son was reported to have an unspecified mental health disorder.