ABSTRACT
A 36 year-old black female, complaining of headache of one month's duration presented with nausea, vomiting, somnolence, short memory problems, loss of weight, and no fever history. Smoker, intravenous drugs abuser, promiscuous lifestyle. Physical examination: left homonimous hemianopsia, left hemiparesis, no papilledema, diffuse hyperreflexia, slowness of movements. Brain CT scan: tumor-like lesion in the splenium of the corpus calosum, measuring 3.5 x 1.4 cm, with heterogeneous enhancing pattern, sugesting a primary CNS tumor. Due to the possibility of CNS infection, a lumbar puncture disclosed an opening pressure of 380 mmH(2)0; 11 white cells (lymphocytes); glucose 18 mg/dl (serum glucose 73 mg/dl); proteins 139 mg/dl; presence of Trypanosoma parasites. Serum Elisa-HIV tests turned out to be positive. Treatment with benznidazole dramatically improved clinical and radiographic picture, but the patient died 6 weeks later because of respiratory failure. T. cruzi infection of the CNS is a rare disease, but we have an increasing number of cases in HIV immunecompromised patients. Diagnosis by direct observation of CSF is uncommon, and most of the cases are diagnosed by pathological examination. It is a highly lethal disease, even when properly diagnosed and treated. This article intends to include cerebral trypanosomiasis in the differential diagnosis of intracranial space-occupying lesions, especially in immunecompromised patients from endemic regions
Subject(s)
Humans , Animals , Female , Adult , Acquired Immunodeficiency Syndrome/diagnosis , Brain Diseases , Trypanosoma cruzi , Trypanosomiasis , Acquired Immunodeficiency Syndrome/parasitology , Brain Diseases , Fatal Outcome , Nitroimidazoles , Tomography, X-Ray Computed , Trypanocidal Agents , TrypanosomiasisABSTRACT
Os autores avaliaram retrospectivamente 580 pacientes com diagnóstico de SIDA. Destes, 34 haviam realizado biópsia hepática (25 masc., 9 fem., idade média 40,5anos). Do ponto de vista epidemiológico, os fatores que favoreceram o contágio foram a drogadiçäo, o homossexualismo e a realizaçäo de transfusäo de sangue. Cliicamente, 33 por cento apresentavam hepatomegalia, 19 por cento esplenomegalia, 9 por cento icterícia e 3 por cento ascite. Havia alteraçäo de provas de funçÝo hepática em 68 por cento dos casos. Do ponto de vista histológico, a biópsia permitiu o diagnóstico de infecçöes oportunistas e o comprometimento neoplásico do fígado em 21 e 9 por cento dos casos, respectivamente