Reactivation of Chagas Disease in a Patient with Advanced HIV 15 Years After Migration: Case Report

Laura O'Doherty^1*Annmarie White¹Ali Almajrafi¹Alain Fennessy¹Arlene Heekin¹Peter Bede^1,2Brendan Crowley¹Laura Nabarro³Debbie Nolder³Claire Rogers⁴Catherine Moran⁵Alan Beausang⁵Sean Keane¹Michell Cruz¹Emma Devitt^1,2Colm John Bergin^1,2

• ¹St. James's Hospital, Dublin, Ireland
• ²Trinity College Dublin, Dublin, County Dublin, Ireland
• ³Hospital for Tropical Diseases, London, United Kingdom
• ⁴London School of Hygiene and Tropical Medicine, University of London, London, London, United Kingdom
• ⁵Beaumont Hospital, Dublin, Ireland

Chagas disease is a neglected tropical disease caused by the protozoan parasite Trypanosoma cruzi. Chagas disease reactivation is an opportunistic infection in HIV positive patients commonly presenting as meningoencephalitis and/or central nervous system abscesses. We describe the first known Irish case of reactivation disease in a young patient from a Chagasendemic region with previously undiagnosed HIV and profound immunocompromise. More than fifteen years after migrating, he presented to hospital with headache, fever, and reduced consciousness. A diagnosis of Chagas disease reactivation was made with neuroimaging, epidemiological history, Chagas serology and a brain biopsy. Despite commencement of antiparasitic therapy followed by anti-retroviral therapy (ART), he deteriorated and died one month after admission. There is no international consensus on the dosing of antiparasitic treatment or the timing of ART initiation in reactivation disease with T. cruzi in people living with HIV (PLWH). This case highlights the need for further research into the management of this complex and highly morbid illness.