AN ALERT FOR CARDIOLOGISTS: SEVERE ACUTE MYOCARDITIS WITH HEART FAILURE AS INITIAL PRESENTATION OF ORAL TRANSMISSION CHAGAS DISEASE IN AN ELDERLY PATIENT

Abstract

• Introduction: Chagas disease, a parasitic zoonosis endemic in the Americas, is classically a cause of dilated cardiomyopathy in its chronic phase. We report an atypical and severe case of acute cardiac presentation, triggered by oral transmission. • Case Report: A 68-year-old male patient, previously healthy, from an endemic area of Brazil, presented with 21 days of fever, malaise and myalgia, progressing with anuria and lower limb edema. Physical examination revealed hepatomegaly and significant peripheral edema. Epidemiological suspicion (ingestion of contaminated bacaba juice) and direct parasitological confirmation (visualization of Trypanosoma cruzi) established the diagnosis of acute phase. Crucial highlight: serology was negative. Echocardiography revealed severe heart disease at the time of presentation: significant left atrial dilation (49 mL/m²), eccentric ventricular hypertrophy, diastolic dysfunction and discrete pericardial/pleural effusions, with preserved ejection fraction (75%). • Conclusion: This case demonstrates that acute Chagas disease, particularly by oral transmission, can manifest as severe acute myocarditis with rapidly onset heart failure, challenging the paradigm of exclusively late cardiac involvement. Cardiologists in non-endemic regions should include this entity in the differential diagnosis of febrile patients with myocarditis or heart failure of obscure origin and history of travel to at-risk areas. Negative serology in the acute phase does not exclude the diagnosis, requiring direct parasitological methods.