Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2024;14(2):e2024081 1

Chagas Disease (American Trypanosomiasis)
Stefano Veraldi1, Gianluca Nazzaro2 

1 Dermatological Centre in Milan, Milan, Italy

2 SC Dermatologia, IRCCS Foundation, Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

Citation: Veraldi S, Nazzaro G. Chagas Disease (American Trypanosomiasis). Dermatol Pract Concept. 2024;14(2):e2024081.  
DOI: https://doi.org/10.5826/dpc.1402a81

Accepted: October 30, 2023; Published: April 2024

Copyright: ©2024 Veraldi et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, 
distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing Interests: None.

Authorship: Both the authors have contributed significantly to this publication. 

Corresponding Author: Stefano Veraldi, Dermatological Centre in Milan, Milan, Italy. E-mail: stefano.veraldi@dcim.it

Case Presentation

A 33-year-old male, recently returned from a trip to   

Argentina, was admitted with an ulcer on the left temple, 

erythematous oedema of the left eyelid, ulcer on the left 

cheek (Figure  1  A, B), and left preauricular and laterocer-

vical lymphadenopathy. The patient complained of fever 

(≤38.4°C), headache, arthralgia, and myalgia. A diagnosis 

of ecthyma gangrenosum was made. Bacteriological exam-

ination was positive for Staphylococcus aureus. Laboratory 

tests showed leukocytosis with lymphocytosis and increased 

erythrocyte sedimentation rate and C-reactive protein. 

 According to antibiogram results, the patient was treated 

with i.m. ceftriaxone (2 g/day for 10 days). He was seen 

again two weeks later; however, all symptoms persisted. We 

then remembered the patient’s trip to Argentina, and a di-

agnosis of Chagas disease (American trypanosomiasis) was 

hypothesized. Indirect immunofluorescence and ELISA test 

were positive for Trypanosoma cruzi infection. The patient  

was treated with oral benznidazole (375 mg/day for  

two months). Complete remission was observed six weeks 

later. Two-year follow-up was negative. 

Teaching Point

Chagas disease is caused by protozoan Trypanosoma cruzi. It 

is endemic in Central and South America. It is usually trans-

mitted by feces of bedbugs of the subfamilies Reduviidae and 

Triatominae, in particular Triatoma infestans. Reservoirs are 

wild animals and humans. However, Chagas disease can be 

transmitted also by blood transfusion, solid organ trans-

plant, and food contaminated by feces of the bedbugs. Acute 

Chagas disease is characterized by fever, arthralgia, myalgia, 

and Romaña sign (unilateral erythematous oedema, con-

junctivitis, and preauricular lymphadenitis). Benznidazole 

and nifurtimox are the drugs of choice [1,2].



2 Image Letter | Dermatol Pract Concept. 2024;14(2):e2024081

References

1. Patel S, Sethi A. Imported tropical diseases. Dermatol Ther. 

2009;22:538-549. DOI: 10.1111/j.1529-8019.2009.01275.x

2. Hemmige V, Tanowitz H, Sethi A. Trypanosoma cruzi  infection: a 

review with emphasis on cutaneous manifestations. Int J Derma-

tol. 2012;51:501-508. PMCID: PMC3552304 DOI: 10.1111 

/j.1365-4632.2011.05380.x

Figure 1. (A, B) Ulcer located on the left temple, erythematous 

edema of the left eyelid, and ulcer on the left cheek.