Meningoencefalitis Chagásica en paciente como forma de debut de una infección por el virus HIV

Dora Montiel; Katherin Araujo; Elias Rodríguez; Karen Maidana; Enrique García; Amalia González

doi:10.53732/rccsalud/e8905

Authors

Dora Montiel Hospital Nacional de Itauguá, Centro Médico Nacional. Itauguá, Paraguay https://orcid.org/0000-0003-1587-7836
Katherin Araujo Hospital Nacional de Itauguá, Centro Médico Nacional. Itauguá, Paraguay https://orcid.org/0009-0001-8418-8324
Elias Rodríguez Hospital Nacional de Itauguá, Centro Médico Nacional. Itauguá, Paraguay https://orcid.org/0009-0009-3483-0233
Karen Maidana Hospital Nacional de Itauguá, Centro Médico Nacional. Itauguá, Paraguay https://orcid.org/0009-0004-6258-4512
Enrique García Hospital Nacional de Itauguá, Centro Médico Nacional. Itauguá, Paraguay https://orcid.org/0000-0001-7367-6296
Amalia González Hospital Nacional de Itauguá, Centro Médico Nacional. Itauguá, Paraguay https://orcid.org/0009-0004-6260-654X

DOI:

https://doi.org/10.53732/rccsalud/e8905

Keywords:

trypanosoma cruzi, HIV, Chagas disease reactivation, benznidazole

Abstract

A 57-year-old male farmer consults our hospital with a 30-day history of fever, weight loss, asthenia, anorexia. 48 hours before admission he presented incoherent speech. Upon admission the patient presented marked protein-calorie malnutrition, Glasgow 13/15, psychomotor excitation, CSF protein 907 mg/dl, glucose 30 mg/dl, leukocytes 16 cells/field with mononuclear predominance. Analysis of cerebrospinal fluid (CSF), direct examination showed trypomastigotes of Trypanosoma cruzi. Peripheral blood smear: hemoparasite compatible with Trypanosoma cruzi was observed. HIV serology (+), CD4 92, viral load 1,672,532 copies. The patient was treated with 5 mg/kg/day of beznidazole, received prophylaxis with TMS-SMS, azithromycin for advanced immunosuppression, and antiretroviral therapy. On day 10 of treatment, he developed a generalized skin rash, interpreted as an adverse effect of treatment. Beznidazole and trimethoprim sulfa were discontinued. Family members requested discharge. The patient's progress is unknown.

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