Cerebral trypanosomiasis and AIDS.
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.


METHODS
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, suggesting 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 immunocompromised 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 immunocompromised patients from endemic regions.
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis*; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000469:parasitology; D000328:Adult; D000818:Animals; D020808:Central Nervous System Protozoal Infections / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000469:parasitology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D009593:Nitroimidazoles / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D014344:Trypanocidal Agents / Q000627:therapeutic use; D014349:Trypanosoma cruzi / Q000302:isolation & purification*; D014352:Trypanosomiasis / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000188:drug therapy
D009593:Nitroimidazoles; D014344:Trypanocidal Agents; C009999:benzonidazole