Acute pericarditis and Chagas cardiomyopathy in an infant: misleading presentation as gastroenteritis in the emergency department

Abstract

Chagas disease, caused by Trypanosoma cruzi, continues to be a public health problem in endemic regions, where oral transmission has increased its epidemiological relevance. We present the case of an 11-month-old infant who was referred for fever, generalized rash, and diarrhea. Initial studies showed moderate anemia and systemic inflammation. Given the persistence of symptoms during hospitalization, additional tests were performed, revealing leukocytosis, organomegaly, and cardiac involvement characterized by repolarization abnormalities and pericarditis with progressive effusion. Although most direct parasitological tests were negative, thick smear microscopy confirmed the presence of T. cruzi trypomastigotes. Symptomatic management and treatment with benznidazole were initiated, followed by transfer to a more complex center, where the clinical course was favorable. This case highlights the importance of considering Chagas disease in the differential diagnosis of infants with fever and nonspecific systemic manifestations, especially in contexts of risk for oral transmission.