Esophageal Involvement in Congenital Chagas' Disease

Report of a Case with Megaesophagus

Achiléa Lisboa BittencourtDepartment of Pathology and Department of Preventive Medicine, School of Medicine, Federal University of Bahia (UFBA), Pediatric Service and Radiology Service, Hospital Prof. Edgard Santos, UFBA, Department of Tropical Public Health, Harvard School of Public Health, Boston, Massachusetts 02115, Brazil

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Graciette Oliveira VieiraDepartment of Pathology and Department of Preventive Medicine, School of Medicine, Federal University of Bahia (UFBA), Pediatric Service and Radiology Service, Hospital Prof. Edgard Santos, UFBA, Department of Tropical Public Health, Harvard School of Public Health, Boston, Massachusetts 02115, Brazil

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Heleno Cabral TavaresDepartment of Pathology and Department of Preventive Medicine, School of Medicine, Federal University of Bahia (UFBA), Pediatric Service and Radiology Service, Hospital Prof. Edgard Santos, UFBA, Department of Tropical Public Health, Harvard School of Public Health, Boston, Massachusetts 02115, Brazil

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Eduardo MotaDepartment of Pathology and Department of Preventive Medicine, School of Medicine, Federal University of Bahia (UFBA), Pediatric Service and Radiology Service, Hospital Prof. Edgard Santos, UFBA, Department of Tropical Public Health, Harvard School of Public Health, Boston, Massachusetts 02115, Brazil

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James MaguireDepartment of Pathology and Department of Preventive Medicine, School of Medicine, Federal University of Bahia (UFBA), Pediatric Service and Radiology Service, Hospital Prof. Edgard Santos, UFBA, Department of Tropical Public Health, Harvard School of Public Health, Boston, Massachusetts 02115, Brazil

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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.

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