Fulminant and fatal Trypanosoma cruzi reactivation in a patient with lymphoma

Sep 29, 2026

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Trypanosoma cruzi is a protozoan parasite and cause of Chagas disease. This case reports a fulminant, fatal reactivation of T. cruzi after immunosuppression in a patient with a history of follicular lymphoma, with parasitemia detected on peripheral blood smears and parasites identified in multiple autopsy tissue specimens. A 61-year-old woman on obinutuzumab and zanubrutinib developed persistent COVID-19 pneumonia, and subsequent therapies led to identification of parasites and death despite benznidazole treatment.

LanguageEnglish

CategoryHealthcare

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Abstract

Case Presentation

COVID-19 course and immunosuppression

Microbiologic workup and key findings

Conclusion

| Epidemiology | Case Report Fulminant and fatal Trypanosoma cruzi reactivation in a patient with lymphoma Georgi Lukose,1 Anna Mertelsmann,2,3,4 Rebecca M. Marrero Rolon,1 David J. Pisapia,1 Sanjay Patel,1 Christina Coyle,5 Lars F. Westblade,1,4,6 Michael Satlin,1,4 Jamie Marino1 AUTHOR AFFILIATIONS See affiliation list on p. 6. ABSTRACT Background Trypanosoma cruzi is a protozoan parasite and the causative agent of Chagas disease. This case describes a fulminant and fatal reactivation of T. cruzi after immunosuppression in a patient with a history of follicular lymphoma, with parasitemia detectable in peripheral blood smears and parasites seen in multiple autopsy tissue specimens. Case Summary A 61-year-old woman who had immigrated from El Salvador and was receiving obinutuzumab and zanubrutinib for follicular lymphoma in remission was admitted with persistent COVID-19 pneumonia. After multiple therapies for COVID-19, including more than 3 weeks of corticosteroid therapy for the possibility of organizing pneumonia, a peripheral blood smear identified T. cruzi trypomastigotes, and lateramastigotes were identified in a bone marrow biopsy. The patient was treated with benznidazole but ultimately died. At autopsy, amastigotes were observed in multiple organs, including the heart, esophagus, stomach, small intestine, colon, bladder, and skeletal muscle. Conclusion Most cases of Chagas reactivation are described in people living with HIV-1 or transplant recipients. Rarely, T. cruzi reactivation can occur in patients undergoing immunosuppressive therapies for malignancies or inflammatory states like COVID-19 infection, as seen in this case. If not recognized early, reactivation can be fatal despite antiparasitic treatment. Providers should consider screening patients from endemic areas who will start on immunosuppressive therapies. Repeating screening may be of value with periods of new immunosuppression. In patients with Chagas disease and malignancy, PCR from blood should be performed during enhanced immunosuppression so that preemptive treatment can be initiated prior to the presentation of fulminant disease. KEYWORDS Trypanosoma cruzi, reactivation, Chagas disease, lymphoma C hagas disease, also known as American trypanosomiasis, is a disease caused by infection of the protozoan parasite Trypanosoma cruzi (1–3) . Considered a neglected tropical disease, it affects an estimated 6 million people in Latin America (4) . Due to increased migration, it has become a global health concern with approximately 288,000 infected persons in the United States, many of whom remain undiagnosed (3–7) . Trypanosoma cruzi results in a lifelong infection and can establish long-term persistence (chronic infection) when untreated, where 20%–30% of cases will progress to severe cardiac or gastrointestinal disease (1, 3, 8) . Patients with chronic Chagas disease with significant dysfunction of one or more immune mechanisms can have uncontrolled Editor Carey-Ann D. Burnham, Pattern Bioscience, Austin, Texas, USA Address correspondence to Jamie Marino, cornell edu replication of the parasite, leading to high levels of parasitemia with severe complications (6, 9) . Reactivation is most frequently reported in people with HIV-1 with low CD4 cell counts and those individuals undergoing immunosuppressive therapy after transplant, but it is less commonly reported in malignancy (6, 7, 9) . In this report, we describe a case of a fulminant and fatal reactivation of Chagas disease in a patient who had immigrated to the United States to highlight the importance of considering reactivation during periods of increased immunosuppression. CASE PRESENTATION The patient was a 61-year-old woman with a history of follicular lymphoma, which was diagnosed 5 years previously when she had presented with a retroperitoneal mass. The patient’s lymphoma had initially responded to chemotherapy. Two years prior to the current presentation, the patien

FAQs

What condition triggered T. cruzi reactivation in this case?

Reactivation followed immunosuppression in a patient with follicular lymphoma treated with agents including obinutuzumab and zanubrutinib, alongside corticosteroid therapy during COVID-19 pneumonia.

How was T. cruzi detected before the fatal outcome?

T. cruzi was identified on peripheral blood smear as trypomastigotes, with lateramastigotes detected on bone marrow biopsy.

Which organs showed parasitic infection at autopsy?

Amastigotes were observed in multiple organs including the heart, esophagus, stomach, small intestine, colon, bladder, and skeletal muscle.

Sep 29, 2026

Uploaded by Elsa