A 32‐Year‐Old Brazilian Woman with Severe Headache and Fever

Abstract

Diagnosis: Chagasic meningoencephalitis. Giemsa staining of a CSF sample revealed motile parasites determined to be Trypanosoma cruzi (figure 2). Despite treatment with orally administered benznidazole (10 mg/kg per day), the disease took a fulminant course from progressively neurological dysfunction to coma, and the patient died <5 days after presentation. Chagas disease is one of the most important parasitic diseases in Latin America [1]. Reactivation of chagasic infection has been reported in patients who have undergone transplantation, who have hematologic cancer, or who have HIV infection and has sometimes been the first HIV-associated opportunistic infection reported [2, 3]. In these patients, T cruzi infection most commonly affects the CNS. Myocarditis has also been reported in these patients, usually in association with major CNS involvement [2-4]. The clinical manifestations of T cruzi infection are acute meningoencephalitis (unifocal or multifocal) with fever, headache, vomiting, seizures, and focal neurological signs. The majority of patients have a low CD4 lymphocyte count (range, ii i` `:ii:ii ii ii.i ..i.i i.`i .