15-year-old female patient,
coming from the province of Chaco, with diagnosis
Acute lymphoblastic leukemia (ALL) two years ago,
with good response to treatment, receiving
at the time of admission as maintenance,
6-mercaptopurine daily and weekly metrotexate
oral use, followed by the Children's Hospital
Runners.
Serology for Chagas negative
starting leukaemia therapy.
She is admitted to the hospital due to an approximate picture
20 days of evolution of frontal headache
daily febrile records, then
spontaneous; upon admission
you feel oppressed when you get up.
1.
The physical examination showed no particularities,
except central obesity with a neurological examination
No deficit.
The studies performed reported: blood cells
white: 4200 mm (neutrophils 88%, lymphocytes)
10%, monocytes 2%), haemoglobin 12 g%, blood count
platelets 398 000/mm; LDH 853 U/l, urea
26 mg%, acetylsalicylic acid 3.1 mg%, GOT 74 IU, GPT 47
IU, anicteric serum, T Quick 100%, KPTT 30 sec,
2 negative blood cultures.
Brain computed tomography: extensive lesion
impaired liver function
left occipitoparietal white, compatible with
vasogenic oedema.
Brain Magnetic Resonance Imaging (MRI)
1 and 2): left occipital lobe is observed
Hypointense lesion on T1-weighted and heterogeneous
hyperintense on T2, especially in peripheral region
e isointense in central portion, margins
frankly irregular.
With gadolinium sample
peripheral staining with central hypointense area surrounded by
significant vasogenic oedema causing mass effect and partially obliterating the
neighborhood grooves, collapse and displacement
left ventricular atrium.
Normal chest X-ray, echocardiogram
normal.
Normal value.
Serology: VHI (Elisa): non-reactive; VDRL: no
toxoplasmosis (HAI) IgM and IgG negative,
cytomegalovirus IgG positive, IgM negative;
E. cruzi infection positive, IgM negative; herpes simplex
1 and 2 IgG positive, IgM negative; hepatitis A,
B, C IgG and IgM negative.
Serology for Chagas: Elisa (enzyme immunoassay)
recombinant qualitative method of
third generation positive.
AIH (magglutination)
indirect) positive; titres greater than 1:16.
IFI
(indirect immunofluorescence) positive; titres
1:64.
According to the World Health Organization
Health (WHO) 2 positive reactions are needed
of 3 performed to consider an individual
As chagasic.
Paracoccidioidomycosis: microsatellite technique.
Sealing
observed an average of 15 trypsites/ml
blood.
Lumbar puncture: normal cytochemical.
Culture
negative.
Pathogenic cells were not observed.
No seizures were observed.
Start treatment with benidazole 7 mg/kg/
oral use.
Treatment
was performed at the same dose for 6 months.
Sealing
blood counts were performed once a week during
the first month, then once a month.
No
side effects were observed during treatment.
One week later, the patient was asymptomatic
and with negative parasitemia, the
Hospital discharge with outpatient follow-up.
Sealing
weekly parasitemias were performed during the first month, all negative.
After one month of treatment, new treatments were performed.
IFI serology (indirect immunofluorescence),
Loss of title
antibodies.
Initial magnetic resonance imaging
Brain size was 13 mm. One month later, a transient ischaemic attack was observed.
size decrease.
The image
6 months treatment was
5 mm, with decreased perilesional oedema.
One year after stopping treatment,
The patient is asymptomatic
cognitive or motor sequelae, with resonance imaging
improved brain.
With negative parasitemia and serologies
negative for Chagas.
