Cerebral trypanosomiasis and AIDS

Arquivos de Neuro-Psiquiatria

Apio Claudio Martins Antunes¹  Felipe Martins De Lima Cecchini¹  Fernando Von Bock Bolli¹  Patricia Polanczyk De Oliveira¹  Ricardo Gurgel Rebouças¹  Thais Lampert Monte¹  Daniele Fricke¹ 

[1] ,Hospital de Clínicas de Porto AlegrePorto Alegre RS ,Brasil

关键词: trypanosomiasis;    trypanosoma cruzi;    AIDS;    benznidazole;    nifurtimox;    tripanossomíase;    tripanosoma cruzi;    SIDA;    benzonidazol;    nifurtimox;   

DOI  :  10.1590/S0004-282X2002000500009

来源: SciELO

【 摘 要 】

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.

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