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Esophageal involvement in congenital Chagas' disease. Report of a case with megaesophagus
Insights
Congenital Chagas' disease can present in newborns with severe digestive issues like megaesophagus. This case highlights an acute digestive form, emphasizing the need for early diagnosis and intervention in infants.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Parasitology
Background:
- Congenital Chagas' disease is rare, often presenting with vague symptoms or remaining undiagnosed until later stages.
- Digestive manifestations, such as megaesophagus, are typically associated with chronic Trypanosoma cruzi infection.
Observation:
- A full-term infant exhibited immediate postnatal feeding difficulties, including dysphagia, vomiting, and regurgitation.
- At five months, the infant presented with malnutrition and radiographically confirmed megaesophagus, alongside positive serology for Trypanosoma cruzi (IgM).
Findings:
- Autopsy revealed marked esophageal dilation, significant neuronal loss in Auerbach's plexus, inflammation, and parasite nests in the esophagus and bladder.
- Histopathological findings suggest an acute digestive phase of Chagas' disease, rather than the chronic phase.
Implications:
- This case represents the fourth documented instance of congenital Chagas' disease with esophageal involvement and the first with gross post-mortem evidence of megaesophagus.
- Highlights the potential for acute digestive presentations of congenital Chagas' disease, necessitating heightened clinical suspicion and diagnostic efforts in neonates with relevant symptoms.
Abstract:
A full-term infant developed dysphagia, vomiting, and regurgitation immediately after birth. On examination at 5 months of age, he was malnourished and had radiographically proven megaesophagus. On direct examination his blood was positive for Trypanosoma cruzi. Additionally an enzyme immunoassay for T. cruzi IgM antibodies was positive. He underwent corrective surgery for the megaesophagus but died post-operatively of aspiration pneumonia. At autopsy, the esophagus was markedly dilated. There was an extreme reduction of neurons in Auerbach's plexus, and inflammation of this plexus and the muscular layer of the esophagus. Nests of parasites were seen in the esophagus and bladder. It is suggested that this patient was not in the chronic phase of Chagas' disease but represents an acute digestive phase of this infection. This is the fourth case in the literature of congenital Chagas' disease with esophageal involvement and clinical signs, and the first in which megaesophagus was seen grossly at post-mortem examination.