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Case Report of Cardiac Tamponade Due to acute Chagas Disease after Misdiagnosis of Visceral Leishmaniasis Based on Serology

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Case Reports in Clinical Medicine 2022年第10期11卷 435-441页

作者： Valéria R. Corrê a Welyda R. Lima Luis. F. D’A. e Castro Heitor F. A. Junior Marina C. Affonso Leonardo P. N. Silva Department of Medicine Hospital Regional de Araguaína Araguaína Brazil Department of Pathology and Protozoology Laboratory FMUSP S&atilde o Paulo Brazil Department of Medicine Faculty of Medicine S&atilde o Caetano do Sul S&atilde o Caetano do Sul Brazil Department of Medicine Centro Universitário Tocantinense Presidente Ant&ocirc nio Carlos Araguaína Brazil

Protozoan diseases such as Visceral Leishmaniasis (VL) have re-emerged in Northern Brazil and cases of Chagas Disease also occur. This VL increase leads to early therapy for the public. Confirmatory parasitological diagnoses in VL are performed by bone marrow or spleen aspiration, but ELISA, IFA or immunochromatographic tests for antibody detection are easily performed and can be used in the presence of clinical signs as confirmatory for specific therapy. This approach is successful in providing therapy and prevention of death in VL, but there is a chance of confusion with the emerging disease, Chagas Disease (CD), due to cross-reacting and similar clinical pictures, as in this case. Both VL and CD presented many asymptomatic or oligosymptomatic cases, complicating the picture. Our case report emphasizes these aspects. Positive serology, with an IIF titer of 1/160, and epidemiological correlation, suggests the diagnosis of VL and imposes antimony therapy. Despite the unfavorable evolution and signs of cardiac involvement, the presence of pericarditis and cardiac tamponade confirmed by the echocardiogram suggests CD. We reassessed the profiles of a suggested CD serology, the diagnosis was corrected and treatment with CD specific benznidazole. The good evolution started with benznidazole corroborates the diagnosis of CD and discards the hypothesis of double infection.

关键词： Heart Cardiac Tamponade trypanosomiasis acute Serology

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