IJCS | Volume 32, Nº5, September/October 2019

DOI: 10.5935/2359-4802.20190010 546 CASE REPORT International Journal of Cardiovascular Sciences. 2019;32(5):546-550 Mailing Adress: Andrés Ricardo Pérez Riera R. Nicolau Barreto, 258. Postal Code: 04583-000, Vila Cordeiro, São Paulo, SP - Brazil. E-mail: riera@uol.com.br , arperezriera@gmail.com Complete Resolution of Electrocardiographic Changes Induced by Acute Chagas Myocarditis Joseane Elza Tonussi Mendes Rossette do Valle, 1 Luiz Carlos de Abreu, 2 R aimundo Barbosa Barros, 3 R odrigo Daminello Raimundo, 2 I sabel Cristina Espósito Sorpreso, 4 A ndrés Ricardo Pérez-Riera 2 Secretaria de Estado de Saúde do Acre, 1 Rio Branco, AC - Brazil Faculdade de Medicina do ABC (FMABC), 2 Santo André, SP - Brazil Hospital de Messejana Dr. Carlos Alberto Studart Gomes, 3 Fortaleza, CE - Brazil Universidade de São Paulo, 4 São Paulo, SP - Brazil Manuscript received March 08, 2018; revised manuscript June 26, 2018; accepted July 23, 2018. Chagas Disease/epidemiology; Trypanosoma Cruzi; Chagas Cardiomyopathy; Electrocardiography/methods; Heart Failure/drug therapy; Antiparasitic Agents. Keywords Abstract We present a case of a female adolescent with severe acute Chagas myocarditis, acquired by oral transmission in an endemic area in the Brazilian western Amazon, who had electrocardiographic changes normalized after empirical treatment with the antiparasitic drug benznidazole combined with conventional treatment for severe heart failure. Introduction Chagas disease (CD) is a neglected parasitic infection caused by the protozoan Trypanosoma cruzi, which infects a wide range of triatomines and mammalian species, including man. About 8 million people worldwide are estimated to be infected, and 28 million people are at risk of acquiring the disease in 15 endemic countries of Latin America. Oral transmission of CD has been the most common route of infection in the Amazon region. 1 Since the 1960s, the drugs available for the treatment of the acute phase (0-4 months after infection) of CD have been benznidazole (BZ) and nifurtimox (NFX). 2 BZ administered orally is still the drug of choice in many countries despite its high dosage regimen and adverse side effects such as allergic dermatitis (skin rashes), peripheral neuropathy, anorexia, 3 and less commonly, bone marrow suppression. BZ is also potentially carcinogenic. Patients in the chronic phase of CD treated with BZ and NFX had parasite persistence and progressive electrocardiographic changes, similar to untreated control patients. 4,5 The cardiac form of the disease starts with an acute dilatedmyocarditis, followed by myocardial remodeling, fibrosis, and arrhythmias. Case Report A 12-year-old female, born in the rural area of Rodrigues Alves community, Acre, in western Amazon, northern region of Brazil, was admitted to the regional hospital with fever, dizziness, weakness and vomiting in the last month. A short time earlier, her brother, sister-in-law, and sister had similar symptoms, and her brother and sister-in-law died. The girl’s family earn their living by growing and selling the fruit and juice of açaí (a small, round, dark colored fruit, obtained from a palm tree). Physical examination revealed significant facial edema associated with bilateral periorbital edema, lower limb edema, anasarca, dyspnea on light exertion (NYHA III) and orthopnea. Regular tachycardia (117 bpm), third heart sound (S3) with gallop rhythm and hypotension (80/60 mmHg) were detected, in addition to decreased vesicular breath sounds and pulmonary crepitations in both lung bases. Respiratory rate was 20 breaths/min and O 2 saturation was 98%. The liver was enlarged and tender at 3 cm from the right costal margin accompanied by splenomegaly. No fever was observed (35.6°C). Chest X-ray showed generalized cardiomegaly and blunting of the right costophrenic angle. Echocardiography showed severe deterioration of the left ventricular function with an ejection fraction of 19%