Tumor-like lesion due to Chagas' disease in a patient with lymphocytic leukemia

Abstract

A 73 year-old white male, living in the interior of the state of Mato Grosso do Sul, in central Brazil, after an initial diagnosis of sinusitis was transferred to the neurology service with a 3-day evolution of intracranial hypertension. Exams showed lymphocytic leukemia and a tumor-like lesion, either an expanding inflammatory process such as an abscess or a neoplasm. Treatment with Ceftriaxone and Decadron was started and intracranial hypertension was controlled. Methotrexate was injected on the occasion of the next puncture considering a possible leukemia infiltration. Flagellate forms of T. cruzi were observed in the CSF and treatment with Benznidazole was started. After 4 days the CSF presented fractionated forms of trypomastigotes. The protein level was 27%. Signs of intracranial hypertension ceased. Tomography and magnetic resonance images showed an important reduction of the tumor-like lesion. The clinical condition of the patient improved.

Reactivation of Tumor-like Chagas Disease in the Central Nervous System in Cardiac Transplant Patients: A Case Series and Literature Review

“…7 8 9 10 11 12 13 14 15 16 17 The cases of cerebral chagoma non-related to AIDS found in our review are summarized in Table 1 . Among patients immunosuppressed for causes other than AIDS, the following was found: 1 patient using methotrexate due to rheumatoid arthritis; 18 2 patients with leukemia; 19 20 2 patients undergoing kidney transplantation; 21 22 and only 1 reported case of a patient who underwent a heart transplantation, 4 similar to our case. Such a complication in heart transplant patients is very rare.…”

Reactivation of Chagas' disease leading to the diagnosis of acquired immunodeficiency syndrome

“…Reactivation of chronic Chagas' disease is a rare condition and occurs only in immunosuppressed patients [2,3], probably due to a rupture in the delicate balance between the parasite and the cellular immune system [4]. Patients at especially high risk are those submitted for transplants [5,6], those that have leukemia [2], lymphoma [7], and especially, AIDS [3,4,[8][9][10][11][12][13][14][15][16][17][18][19][20][21].…”

“…Parasitism of CNS can be suggested with the detection of T. cruzi antibodies in the CSF, but definitive diagnosis is made by demonstration of free trypomastigote forms in the CSF [2,5,14,15]. Centrifugation of the CSF enhances the sensibility of the test [26].…”

“…Amastigote forms of T. cruzi are found in glial cells, macrophages, interstitial tissue, and rarely in neurons [2,10,23,24,27]. Lazo et al [27] propose the label of focal necrotizing chagasic meningoencephalitis for chagasic meningoencephalitis of HIV-positive patients, because of its similarity to focal necrotizing toxoplasmic encephalitis.…”

Changing epidemiology and approaches to therapy for Chagas disease

“…The incidence of reactivation of T. cruzi in chronically infected, immunosuppressed patients is unknown, and both its absence [45] and occurrence [46][47][48] have been reported. A handful of reports of reactivation of chronic T. cruzi infection after kidney transplants have appeared, and in two of these patients the central nervous system was involved [14,[49][50][51].…”