A Patient with Erythema Nodosus Leprosum and Chagas Cardiopathy: Challenges in Patient Management and Review of the Literature

Abstract

Abstract. We report a patient with severe multi-bacillary leprosy complicated by recurrent episodes of erythema nodosum necrotisans that required thalidomide and/or corticosteroids during follow-up. Although the patient was from an area to which Chagas disease is endemic, this diagnosis was initially missed and was only investigated when heart failure developed in the patient. The difficulties of managing erythema nodosum necrotisans and heart failure concomitantly and those involved in excluding the diagnosis of acute myocarditis caused by reactivation of Chagas disease secondary to the immunosuppressive regimen are discussed. Other potential causes for the heart failure and possible interactions between the two diseases and their treatments are discussed. We also reviewed the literature for the association between leprosy and Chagas disease, both of which are highly endemic in Brazil. This case emphasizes the importance of searching for subclinical co-infections in leprosy patients because reactions frequently develop during specific treatment in these patients, and these reactions require prolonged therapy with immunosuppressive drugs.

Penile Lepromatous Leprosy in a Patient With Chagas DISEASE.A Case Report

“…Es importante aclarar que muchos de estos pacientes con lepra no se reportaron sintomáticos para la enfermedad de Chagas (15). En estudios electrocardiográficos hechos en pacientes con lepra y mal de Chagas se observó que las anomalías se presentaban casi con la misma frecuencia tanto en pacientes coinfectados como en pacientes con una u otra enfermedad (21).…”

“…Esta producido por el parásito Trypanozoma cruzi, endémico en ciertas zonas del Paraguay (14). Se espera que la afectación simultánea de lepra y enfermedad de Chagas en zonas endémicas resulten de una coincidencia inusual, pero se han reportado casos (15). Los pocos reportes disponibles sobre esta coinfección muestran una asociación de varios subtipos de lepra con miocardiopatía chagásica (16).…”

Case Report: COVID-19 and Chagas Disease in Two Coinfected Patients

“…6 Nevertheless, coinfections can lead to CD reactivation and influence the overall prognoses of the patient. 7,8 COVID-19 is a disease caused by SARS-CoV-2 infection that leads to high rates of respiratory illness and death. 9 Several risk factors have been investigated, such as obesity, type 2 diabetes mellitus, and SAH.…”

“… 6 Nevertheless, coinfections can lead to CD reactivation and influence the overall prognoses of the patient. 7 , 8 …”

Co-Morbid Infections in Hansen's Disease Patients in the United States: Considerations for Treatment

“…13 Significant challenges in patient management have also been described in patients with erythema nodosum leprosum and unrecognized Chagas cardiomyopathy. 14 Since April 2011, efforts have been made to test our population, 51% (61 of 120) of whom are from endemic countries (Brazil and Colombia). To date, we have not identified any patient with chronic Chagas infection.…”