Reactivation of Chagas Disease in a Patient With an Autoimmune Rheumatic Disease: Case Report and Review of the Literature

Abstract

Reactivation of Chagas disease has been described in immunosuppressed patients, but there is a paucity of literature describing reactivation in patients on immunosuppressive therapies for the treatment of autoimmune rheumatic diseases. We describe a case of Chagas disease reactivation in a woman taking azathioprine and prednisone for limited cutaneous systemic sclerosis (lcSSc). Reactivation manifested as indurated and erythematous cutaneous nodules. Sequencing of a skin biopsy specimen confirmed the diagnosis of Chagas disease. She was treated with benznidazole with clinical improvement in the cutaneous lesions. However, her clinical course was complicated and included disseminated CMV disease and subsequent septic shock due to bacteremia. Our case and review of the literature highlight that screening for Chagas disease should be strongly considered for patients who will undergo immunosuppression for treatment of autoimmune disease if epidemiologically indicated.

Keywords: Chagas disease; autoimmune rheumatic disease.

Figure 1.

A, Skin lesions on left medial thigh. B, Skin lesions on right medial thigh.

Figure 2.

A, Biopsy of skin nodules, 200× magnification, hematoxylin and eosin (H&E) stain. Histologic sections show an epidermis with mild spongiosis and an underlying lymphohistiocytic infiltrate. B, Biopsy of skin nodules, 400× magnification, H&E stain. Histologic sections show numerous parasitized histiocytes (demonstrated by arrows). The organisms are circular without a well-defined capsule.