Facial paralysis in the acute form of Chagas disease

A 34-year-old woman attended a religious meeting in Pernambuco, Brazil, where an outbreak of acute Chagas disease was reported due to oral contamination. She developed headache, myalgia, edema, and vomiting. Serological tests were positive for Chagas and a blood smear confirmed the presence of T. cruzi ([Figure 1A]). Ten days after starting treatment with benznidazole, right peripheral facial palsy was observed ([Figure 1B]). Brain MRI and CSF analyses were unremarkable. Facial electroneuromyography showed mild axonal neuropathy ([Figure 1C-F]). Thirty days later, she recovered completely without any corticoids. Facial paralysis could be a rare neurological manifestation of Chagas disease[1], a treatment complication[2],[3] or coincidental.

Figure 1 Peripheral blood smear revealing the presence of Trypanosoma cruzi (A); Patient’s right facial palsy and spontaneous recover and after 30 days (authorized) (B); left facial nerve with normal motor amplitude (C); right facial nerve with decreased motor amplitude (D); left blink reflex with normal R1, R2, and absent R2’ (E); right blink reflex with absent R1 and R2, and normal R2’ (F).

• References

• 1 Fortes-Rêgo J. [Peripheral facial paralysis, polyneuritis and chronic Chagas’ disease]. Arq Neuropsiquiatr. 1985 Dec;43(4):418-21. https://doi.org/10.1590/s0004-282x1985000400014
• 2 Bern C. Chagas’ Disease. N Engl J Med. 2015 Jul;373(5):456-66. https://doi.org/10.1056/nejmra1410150
• 3 Alarcón de Noya B, Ruiz-Guevara R, Noya O, Noya O, Castro J, Ossenkopp J, et al. Long-term comparative pharmacovigilance of orally transmitted Chagas disease: first report. Expert Rev Anti Infect Ther. 2017 Mar;15(3):319-25. https://doi.org/10.1080/14787210.2017.1286979