Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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April 28, 2016
Cerebral Chagas Disease (Chagoma) in a Patient with Previously Unknown AIDS
- Background:
- Chagas disease is the result of an infection caused by the parasite Trypanosoma cruzi that is endemic to Latin America.
- Involvement of the CNS is rare, and most of the cases are due to reactivation of chronic disease (after 10–20 years) in inmunosupressed patients, manifesting as a necrotizing meningoencephalitis and development of cerebral masses.
- Clinical Presentation:
- Headache, fever, progressive neurologic deterioration
- Focal deficits secondary to a brain mass
- Intracranial hypertension
- Key Diagnostic Features:
- Unique or multiple rim-enhancing intraxial masses in a patient with AIDS with low CD4+ cell counts and no response to Toxoplasma treatment, who has been in an endemic area
- In most cases biopsy is necessary for the making the correct diagnosis. PCR can be performed to difference between Toxoplasma and Trypanososma.
- Differential Diagnosis:
- Toxoplasma gondii.—Isolated or multiple lesions in AIDS patient with ring-enhancement and surrounded by edema. When a suspected toxoplasmosis has no response to a specific therapy, chagoma can be suspected if the patient has been in an endemic area.
- Glioblastoma.—May be impossible to differentiate on the basis of imaging only
- Primary lymphomas.—Most frequently will have restricted diffusion of the enhancing components. Also, it shows a solid pattern of enhancement, but AIDS-related lymphoma can show peripheral irregular enhancement.
- Metastases.—Rarely involved the corpus callosum
- Treatment:
- Poor prognosis in spite of antiretroviral and antiparasitic treatment
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