Tumor-like lesion due to Chagas' disease in a patient with lymphocytic leukemia Massa cerebral devido a Doença de Chagas em paciente com leucemia linfocítica

• Published in: Revista do Instituto de Medicina Tropical de São Paulo
• Main Authors: Pedro Rippel Salgado, Anthony Guerra Gorski, Andréa Ribeiro Aleixo, Eugênio Oliveira Martins de Barros
• Format: Article in Journal/Newspaper
• Language: English
• Published: Universidade de São Paulo (USP) 1996
• Subjects: Chagas' disease; Leukemia; Tumor-like lesion; Arctic medicine. Tropical medicine; RC955-962; Infectious and parasitic diseases; RC109-216; Arctic
• Online Access: https://doi.org/10.1590/S0036-46651996000400008; https://doaj.org/article/8909a642d8db4eb0ad908e62172c5fd6

A 73 year-old white male, living in the interior of the state of Mato Grosso do Sul, in central Bra­zil, after an initial diagnosis of sinusitis was transferred to the neurology service with a 3-day evolution of intracranial hypertension. Exams showed lymphocytic leukemia and a tumor-like lesion, either an expanding inflammatory process such as an abscess or a neoplasm. Treatment with Ceftriaxone and Decadron was started and intracranial hypertension was controlled. Methotrexate was injected on the occasion of the next puncture considering a possible leukemia infiltration. Flagellate forms of T. cruzi were observed in the CSF and treatment with Benznidazole was started. After 4 days the CSF presented fractionated forms of trypomastigotes. The protein level was 27%. Signs of intracranial hypertension ceased. Tomography and magnetic resonance images showed an important reduction of the tumor-like lesion. The clinical condition of the patient improved. Paciente masculino, 73 anos, do interior de Mato Grosso do Sul, com diagnóstico inicial de sinusite, evoluiu em 3 dias para quadro de hipertensão intracraniana severa. Transferido para o serviço de neurologia, os exames evidenciaram leucemia linfocítica e indicaram ainda processo inflamatório expansivo como abscesso ou tu­ mor (exame do liquor e tomografia). Instituiu-se Ceftriaxone e Decadron. Foi feita nova punção lombar, injetou-se metotrexate considerando possível infiltração leucêmica. No liquor observou-se formas flagelares de T. cruzi. Iniciou-se benzonidazol. Após 4 dias o liquor apresentou formas fracionadas de tripomastigotas. O nível de proteínas se estabilizou cm 27%. Cessou a sintomatolo­gia da hipertensão. Tomografia e ressonância magnética posterior mostraram importante redução da formação tu-moral observada anteriormente. Houve melhora das condições clínicas do paciente.