INVESTIGADORES
RUYBAL paula
congresos y reuniones científicas
Título:
Chagas disease panniculitis in a patient with AIDS
Autor/es:
LOPEZ CARLOTA; AGUIRRE NERINA; GERSZTEIN ANDREA; ANGULO A; LOPEZ RIOS S; DELLAVEDOVA LUISA; RUYBAL PAULA
Reunión:
Congreso; 18th ICID | International Congress on Infectious Diseases; 2018
Resumen:
Background: Chagas disease is an endemic trypanosomiasis in Latin America. Trypanososma cruzi is the etiological agent of the disease. The acute illness is usually self-limited due to acell-mediated immune response that controls parasite replication, turning to a chronic phase characterized by lifelong low-grade parasitemia. Reactivation of Chagas Diseasehas been described in immunocompromised hosts. In HIV-infected patients, has been most commonly associated with meningoencephalitis and myocarditis. The following is adescription and analysis of an AIDS patient who presented erythema nodosum associated with a reactivation of Chagas disease.Methods & Materials: A 56-year-old woman born in Santiago del Estero, Argentina was admitted with a history of fever, weight loss, non-productive cough and dyspnea lasting 6 months. She hadlesions in her right arm and leg, and her left shoulder consisting in erythematous, indurate, painful plaques and nodules compatible with erythema nodosum. The lesions evolvedwith central ulceration. Test for antibodies to HIV were positive. Serological tests for Chagas disease resulted positive. Molecular diagnosis was performed from skin biopsyand cerebrospinal fluid samples. The DNA was extracted using QIAGEN Mini kit and tested by T. cruzi specific PCR (Tcz1 and Tcz2 primers).Results: Cytology study from a sample of one subcutaneous nodule performed by fine needle aspiration (FNA) revealed abundant histiocytes with intracytoplasmic amastigotes. A skinbiopsy using H&E showed diffuse lympho-histiocytic infiltrate, abundant bluish-gray amastigotes (Giemsa stain positive) with round to oval bodies inside and outside thehistocytes cytoplasm distributed along the epidermis. PCR from skin was positive and enabled the detection of T. cruzi in cerebrospinal fluid. The patient was empiricallytreated with cotrimoxazole and prednisone for Pneumocystis jirovecii. She started benznidazol 5mg/kg/12 hours and by the 14th day HAART with tenofovir/emtricitabine anddarunavir/ritonavir was initiated. The patient experienced a good clinical outcome, with no new skin lesions and no drug-related adverse reactions.Conclusion: The presence of parasites in the skin is unusual for Chagas disease. Finally, immunosuppressed patients, especially in endemic areas, should be investigated for T. cruziinfection and should be closely monitored during the immunosuppression.