Chagasic granulomatous encephalitis in immunosuppressed patients. Computed tomography and magnetic resonance imaging findings.
American trypanosomiasis (Chagas' disease), a zoonosis caused by Trypanosoma cruzi with a high incidence in Latin America, may induce an uncommon form of localized encephalitis termed "chagoma", found in few immunocompromised patients. The computed tomography (CT) and magnetic resonance imaging (MRI) findings of brain chagoma are reported for 3 males (ages 32, 32 and 9 yr), the first 2 infected with human immunodeficiency virus (HIV) and the third with acute lymphoblastic leukemia. Diagnosis was confirmed by biopsy. CT disclosed a single, supratentorial, nodular-shaped lesion that substantially enhanced with contrast material, localized in parietal or frontal lobes. T1-weighted MRI showed hypointense lesions that enhanced with gadolinium-diethylenetriaminepentaacetic acid, corresponding to extensive hyperintense areas on T2-weighted images, producing mass effect. The imaging pattern of brain chagoma presented here is similar to that of cerebral toxoplasmosis and should be considered in the differential diagnosis of an intracerebral mass lesion in immunocompromised patients.
Di Lorenzo
G A
GA
Neurological Unit Fernandez Hospital, Department of Neuroimaging, Instituto de Investigaciones, Neurológicas Raúl Carrea-FLENI, Buenos Aires, Argentina.
Pagano
M A
MA
Taratuto
A L
AL
Garau
M L
ML
Meli
F J
FJ
Pomsztein
M D
MD
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000469:parasitology*; D000328:Adult; D014355:Chagas Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002648:Child; D003287:Contrast Media; D003937:Diagnosis, Differential; D004660:Encephalitis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000469:parasitology*; D005625:Frontal Lobe / Q000000981:diagnostic imaging / Q000469:parasitology; D005682:Gadolinium; D019786:Gadolinium DTPA; D006099:Granuloma; D006801:Humans; D007089:Image Enhancement; D016867:Immunocompromised Host; D008279:Magnetic Resonance Imaging; D008297:Male; D009942:Organometallic Compounds; D010296:Parietal Lobe / Q000000981:diagnostic imaging / Q000469:parasitology; D004369:Pentetic Acid / Q000031:analogs & derivatives; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications; D011856:Radiographic Image Enhancement; D014057:Tomography, X-Ray Computed; D016781:Toxoplasmosis, Cerebral / Q000175:diagnosis
D003287:Contrast Media; D009942:Organometallic Compounds; D004369:Pentetic Acid; D005682:Gadolinium; D019786:Gadolinium DTPA