Acute Chagas Disease in a Child From the Interior of Minas Gerais

Chagas disease is a neglected tropical disease and constitutes an important public health problem in Latin America. Although the chronic form of the disease is the most prevalent, 1,271 cases of acute Chagas disease were confirmed in Brazil between 2021 and 2023. In this context, the present report describes a rare case of acute Chagas disease in a pediatric patient with atypical manifestations, initially investigated as a viral infection. A 2-year-and-4-month-old male patient, born and residing in a rural area of Mendes Pimentel, Minas Gerais, with no previous comorbidities, was admitted to a local emergency care service due to pallor for 15 days and an episode of syncope, without other complaints. He had an up-to-date vaccination history according to the National Immunization Program (PNI) and age-appropriate development. On physical examination, the patient was pale, anicteric, and acyanotic, with lymphadenomegaly in the submandibular, axillary, and inguinal regions measuring less than 2 cm, and a liver palpable 5 cm below the right costal margin. Initial laboratory investigation showed hemoglobin of 5 g/dL and hematocrit of 14.9%, leading to hospital admission for investigation of severe acute anemia and transfusional support, guided by a pediatric hematologist. Unexpectedly, the diagnosis of acute Chagas disease was established through direct visualization of the protozoan Trypanosoma sp. in a peripheral blood smear. Serologies for Epstein-Barr virus, cytomegalovirus, parvovirus B19, and toxoplasmosis were negative. The case was immediately reported, and the patient was treated with benznidazole at 10 mg/kg/day, twice daily, for 60 days, progressing to clinical and laboratory remission, with no complications after one year of treatment and outpatient follow-up with a pediatrician. The described case illustrates an uncommon presentation of acute Chagas disease in an immunocompetent pediatric patient, characterized by the absence of typical clinical signs of acute protozoan infection. Therefore, this report contributes to the recognition of possible variations in disease presentation during the acute phase, reinforcing the importance of maintaining Chagas disease among diagnostic possibilities even in atypical clinical scenarios, given that high clinical suspicion and epidemiological surveillance are fundamental for the control of neglected tropical diseases.