Dermatology: Practical and Conceptual Letter to the Editor | Dermatol Pract Concept. 2025;15(1):4770 1 Re: Chagas Disease (American Trypanosomiasis) Alejandro Marcel Hasslocher-Moreno1, André Luiz Land Curi1, Maria Clara Gutierrez Galhardo1 1 Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil Citation: Hasslocher-Moreno AM, Land Curi AL, Gutierrez Galhardo MC. Re: Chagas Disease (American Trypanosomiasis). Dermatol Pract Concept. 2025;15(1):4770. DOI: https://doi.org/10.5826/dpc.1501a4770 Accepted: September 5, 2024; Published: January 2025 Copyright: ©2024 Hasslocher-Moreno 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: All authors have contributed significantly to this publication. Corresponding Author: Dr. Alejandro Marcel Hasslocher-Moreno, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil. E-mail: alejandro.hasslocher@gmail.com Dear Editor, We read with interest the recent article by Stefano Veraldi and Gianluca Nazzaro entitled “Chagas Disease (American Trypanosomiasis)” [1]. The authors present a case involv- ing dermatological and ocular symptoms attributed to acute Chagas disease (CD). The diagnosis was based on positive serology for Trypanosoma cruzi (T. cruzi) using indirect im- munofluorescence and ELISA tests. The patient was treated with benznidazole, leading to regression of the lesions. We would like to offer some comments on this case. First, the dermatological lesions shown in the patient’s facial pho- tograph do not seem consistent with acute chagoma from CD inoculation but, more likely, with acute bacterial infec- tion by staphylococci or streptococci, which would better explain the patient’s systemic symptoms. A chagoma is a painless, hardened swelling at the inoculation site, typically appearing in a single location, that develops within weeks of T. cruzi entry through the skin breach caused by a triatomine bite and that persists for several weeks [2]. As for the in- volvement of the eyelid, this also does not seem compatible with the ophthalmological signs described by Romaña [3]. Second, the diagnosis of the acute phase of CD must be con- firmed exclusively by identifying T. cruzi through a blood smear, as conventional serology for IgG antibodies is not sufficient for diagnosing acute CD unless seroconversion is demonstrated [4,5]. It is possible that the patient already had chronic CD be- fore the clinical episode reported by the authors. Due to the lack of detailed information about the patient’s epidemiolog- ical history - such as whether the patient was born or lived in an area endemic for CD before moving to Italy, whether the patient had received a blood transfusion in recent years, or whether the patient’s mother is from an endemic area for CD - we cannot determine the likely mechanism of trans- mission. Therefore, we request that the authors provide this information and reconsider the diagnosis of acute CD. 2 Letter to the Editor | Dermatol Pract Concept. 2025;15(1):4770 References 1. Veraldi S, Nazzaro G. Chagas Disease (American Trypano- somiasis). Dermatol Pract Concept. 2024;14(2):e2024081. DOI: 10.5826/dpc.1402a81 2. Hemmige V, Tanowitz H, Sethi A. Trypanosoma cruzi infection: a review with emphasis on cutaneous manifestations. Int J Dermatology. 2012;51: 501–508. DOI:10.1111/j.1365-4632 .2011.05380.x 3. Romaña C. Acerca de un sintoma inicial de valor para el diagnos- tico de forma aguda de la enfermedad de Chagas, la conjuntivitis esquizotripanósica unilateral (hipótesis sobre puerta de entrada conjuntival de la enfermedad). [Spanish] Misión de Estudios de Patología Regional Argentina. 1935;22: 16–28. 4. Pinto Dias JC, Novaes Ramos A Jr, Dias Gontijo E, et al. 2nd Brazilian Consensus on Chagas Disease, 2015. Rev Soc Bras Med Trop. 2016;49Suppl 1: 3–60. DOI:10.1590/0037-8682-0505 -2016 5. Bern C, Martin DL, Gilman RH. Acute and Congenital Chagas Disease. Advances in Parasitology. Elsevier; 2011:19–47. DOI:10.1016/B978-0-12-385863-4.00002-2