Chagas Disease: An Interesting Presentation and Diagnosis

Introduction: Chagasdisease is a vector-borne zoonosis that is caused by the protozoan Trypanosomacruzi (T. cruzi) and affects over 8 million people worldwide. Chronic Chagas disease is characterized predominantly by cardiac manifestations, gastrointestinal (digestive) manifestations or a combination of both. The digestive form develops in 10-15% of chronically infected individuals with the two most common manifestations being megaesophagus or megacolon, both of which are resultant from loss of myenteric neurons. Case Report: We report an interesting case of Chagas disease in a patient who had many confounding signs and symptoms of disease resulting in a delay in diagnosis. A 61 year-old male underwent a sigmoid resection for a volvulus. He subsequently underwent multiple admissions for left sided chest pain, abdominal distention and constipation with failed ability to elucidate etiology. He then re-presented 4 years after his original surgery with worsening symptoms. A thorough history revealed he spent time in Mexico. Chagas disease was suspected, and serology was positive. He was then treated conservatively. Discussion: In this case, the patient went misdiagnosed for many years. His confusing presentation with chest pain, along with his diaphragmatic eventration, and ultimate missed diagnosis of Chagas disease led to multiple admissions and limited quality of life. It is important for clinicians to be aware of this clinical entity and to consider testing when dealing with patients with sigmoid volvulus, colonic dilation and/or intestinal dysmotility. Proper diagnosis and direct treatment can avoid unwarranted admissions, unnecessary tests and procedures, and improve patient quality of life.