Tumor-like lesion due to Chagas' disease in a patient with lymphocytic leukemia

Abstract

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 tumor (exame do líquor e tomografia). Instituiu-se Ceftriaxone e Decadron. Foi feita nova punção lombar, injetou-se metotrexate considerando possível infiltração leucêmica. No líquor observou-se formas flagelares de T. cruzi. Iniciou-se benzonidazol. Após 4 dias o líquor apresentou formas fracionadas de tripomastigotas. O nível de proteínas se estabilizou em 27%. Cessou a sintomatologia da hipertensão. Tomografia e ressonância magnética posterior mostraram importante redução da formação tumoral observada anteriormente. Houve melhora das condições clínicas do paciente.

ABSTRACT - 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.