• Mayank Kaushal, Saman Shabani, Elizabeth J Cochran, Hasan Samra, and Nathan T Zwagerman.
• Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
• World Neurosurg. 2019 Sep 1; 129: 225-231.

BackgroundWe document a case of central nervous system infection with Trypanosoma cruzi.Case DescriptionAn 88-year-old woman presented with altered mental status, right-sided weakness, and slurred speech. Her medical history was significant for methotrexate intake for rheumatoid arthritis, and she tested negative for human immunodeficiency virus. Magnetic resonance imaging of the brain showed bilateral thick and peripherally enhancing white matter lesions in the frontoparietal region with extensive surrounding vasogenic edema. A lumbar puncture revealed increased protein and lymphocytic pleocytosis, and needle biopsy highlighted brain necrosis, chronic inflammation, and numerous intracellular organisms suggestive of T. cruzi amastigotes. Despite treatment with benznidazole, the patient expired soon after presentation.ConclusionChagas disease should be included in the differential diagnosis of an immunocompromised patient presenting with a central nervous system mass, meningoencephalitis, or focal neurologic signs.Copyright © 2019 Elsevier Inc. All rights reserved.

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