Reactivation of Chagas Disease in a Patient With an Autoimmune Rheumatic Disease: Case Report and Review of the Literature

Mary M Czech; Ashwin K Nayak; Kavitha Subramanian; Jose F Suarez; Jessica Ferguson; Karen Blake Jacobson; Susan P Montgomery; Michael Chang; Gordon H Bae; Shyam S Raghavan; Hannah Wang; Eugenia Miranti; Indre Budvytiene; Stanford Mervyn Shoor; Niaz Banaei; Kerri Rieger; Stan Deresinski; Marisa Holubar; Brian G Blackburn

doi:10.1093/ofid/ofaa642

Reactivation of Chagas Disease in a Patient With an Autoimmune Rheumatic Disease: Case Report and Review of the Literature

Open Forum Infect Dis. 2021 Feb 5;8(2):ofaa642. doi: 10.1093/ofid/ofaa642. eCollection 2021 Feb.

Authors

Mary M Czech¹, Ashwin K Nayak², Kavitha Subramanian², Jose F Suarez¹, Jessica Ferguson¹, Karen Blake Jacobson¹, Susan P Montgomery³, Michael Chang⁴, Gordon H Bae⁵, Shyam S Raghavan⁶, Hannah Wang⁶, Eugenia Miranti², Indre Budvytiene⁷, Stanford Mervyn Shoor⁸, Niaz Banaei⁷, Kerri Rieger^{5

6}, Stan Deresinski¹, Marisa Holubar¹, Brian G Blackburn¹

Affiliations

¹ Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA.
² Department of Internal Medicine, Stanford University School of Medicine, Stanford, California, USA.
³ Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
⁴ Harvard Medical School, Boston, Massachusetts, USA.
⁵ Department of Dermatology, Stanford University School of Medicine, Redwood City, California, USA.
⁶ Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.
⁷ Clinical Microbiology Laboratory, Stanford Health Care, Stanford, California, USA.
⁸ Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, California, USA.

Abstract

Reactivation of Chagas disease has been described in immunosuppressed patients, but there is a paucity of literature describing reactivation in patients on immunosuppressive therapies for the treatment of autoimmune rheumatic diseases. We describe a case of Chagas disease reactivation in a woman taking azathioprine and prednisone for limited cutaneous systemic sclerosis (lcSSc). Reactivation manifested as indurated and erythematous cutaneous nodules. Sequencing of a skin biopsy specimen confirmed the diagnosis of Chagas disease. She was treated with benznidazole with clinical improvement in the cutaneous lesions. However, her clinical course was complicated and included disseminated CMV disease and subsequent septic shock due to bacteremia. Our case and review of the literature highlight that screening for Chagas disease should be strongly considered for patients who will undergo immunosuppression for treatment of autoimmune disease if epidemiologically indicated.

Keywords: Chagas disease; autoimmune rheumatic disease.

Publication types

Case Reports