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Case Reports
. 2015 Dec;57(6):531-5.
doi: 10.1590/S0036-46652015000600014.

CHAGASIC MENINGOENCEPHALITIS IN AN HIV INFECTED PATIENT WITH MODERATE IMMUNOSUPPRESSION: PROLONGED SURVIVAL AND CHALLENGES IN THE HAART ERA

Renata Buccheri  1 , Maria José Kassab  1 , Vera Lucia Teixeira de Freitas  2 , Sheila Cristina Vicente da Silva  3 , Rita C Bezerra  3 , Zarifa Khoury  1 , Maria Aparecida Shikanai-Yasuda  2 , José E Vidal  1
Affiliations
Case Reports

CHAGASIC MENINGOENCEPHALITIS IN AN HIV INFECTED PATIENT WITH MODERATE IMMUNOSUPPRESSION: PROLONGED SURVIVAL AND CHALLENGES IN THE HAART ERA

Renata Buccheri et al. Rev Inst Med Trop Sao Paulo. 2015 Dec.

Abstract
in English, Portuguese

The reactivation of Chagas disease in HIV infected patients presents high mortality and morbidity. We present the case of a female patient with confirmed Chagasic meningoencephalitis as AIDS-defining illness. Interestingly, her TCD4+ lymphocyte cell count was 318 cells/mm3. After two months of induction therapy, one year of maintenance with benznidazol, and early introduction of highly active antiretroviral therapy (HAART), the patient had good clinical, parasitological and radiological evolution. We used a qualitative polymerase chain reaction for the monitoring of T. cruzi parasitemia during and after the treatment. We emphasize the potential value of molecular techniques along with clinical and radiological parameters in the follow-up of patients with Chagas disease and HIV infection. Early introduction of HAART, prolonged induction and maintenance of antiparasitic therapy, and its discontinuation are feasible, in the current management of reactivation of Chagas disease.

A reativação da doença de Chagas em pacientes com a infecção pelo HIV apresenta uma alta morbidade e mortalidade. Neste relato, apresentamos caso confirmado de meningoencefalite chagásica, como doença definidora de aids, em paciente com 318 linfócitos T-CD4+/mm3. Após 2 meses de tratamento seguido de um ano de profilaxia secundária com benzonidazol e início precoce de terapia antirretroviral (HAART), a paciente apresentou boa evolução clínica, parasitológica e radiológica. Utilizamos a reação em cadeia da polimerase qualitativa do T. cruzi, para monitorização da parasitemia por T. cruzi durante e após o tratamento. Ressaltamos o valor potencial das técnicas moleculares associadas aos parâmetros clínicos e radiológicos nos pacientes com doença de Chagas e infecção pelo HIV. A introdução precoce da terapia antirretroviral, a terapia antiparasitária prolongada, manutenção e descontinuação da mesma, são desafios atuais, embora possíveis, no manejo da reativação da doença de Chagas na era das terapias antirretrovirais de alta eficácia.

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Conflict of interest statement

POTENTIAL CONFLICTS OF INTEREST The authors declare that there are no conflicts of interest

Figures

Fig. 1
Fig. 1. - Contrasted brain computed tomography scan. A) CT at admission showing bilateral areas of gyral enhancement with regional edema, particularly in the right temporo-parietal region; B) CT after 10 days of admission showing persistent gyral enhancement and worsening of adjacent edema in the right temporo-parietal region.
Fig. 2
Fig. 2. - Magnetic resonance imaging two months after the diagnosis of chagasic meningoencephalitis. A) MRI T1 with gadolinium. Gyral enhancement in the right temporo-parietal region; B and C) MRI T2 and FLAIR, respectively. Focus of hyperintensity adjacent to the images described in T1.
Fig. 3
Fig. 3. - Magnetic resonance imaging four months after the diagnosis of chagasic meningoencephalitis. A, B and C) MRI T1 with gadolinium, T2 and FLAIR, respectively. Findings consistent with partial regression of the findings described two months before. The dilation of the posterior right lateral ventricle due to adjacent encephalomalacia is noted.
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