To describe a patient with Chagas' disease diagnosed with concomitant fibromyalgia and treated by an alternative approach and review the fibromyalgia-infections relationship.
The literature was reviewed for fibromyalgia association with infectious agents, using PubMed, spanning 2000-2020. The keywords were: fibromyalgia, infections, bacteria, microbe, and parasite. A case report is described.
A 61-year-old female patient with a past medical history of Chagas' disease, presented with megaesophagus and dolichomegacolon for 30 years. Untreated anxiety accompanied her gastrointestinal manifestations. For the last ten years, she felt diffuse pain on both sides of the body, and in the upper and lower parts associated with sleep difficulties. On examination, she had 18 tender points, thus fulfilled the diagnostic criteria of fibromyalgia. 25-OH vitamin D was 26 ng/mL (>30 ng/mL). Serology for Chagas' disease was positive by two techniques (ELISA and indirect immunofluorescence), and the routine laboratory was within normal ranges. Psychotherapy, vitamin D 50,000 IU/week, and physical exercise (Pilates exercise twice a week and distance walking 3 times per week) were initiated. No antidepressant was prescribed due to the risk of detrimental gastrointestinal motility effects. After six months, the patient experienced a marked improvement in her clinical condition, the pain was almost absent, and anxiety was under control, and vitamin D levels were normal. Her quality of life improved substantially. Reviewing the literature on associated infections in myalgia/fibromyalgia disclosed multiple viral, bacterial, and parasitic agents. None mentioned Trypanosoma cruzi.
The present case illustrates the first patient with Chagas-related dolichomegacolon who evolved with fibromyalgia and was successfully treated by psychotherapy, Pilates exercise, and vitamin D. It appears that myalgia and/or fibromyalgia are associated with numerous infectious agents, including parasites, but the association of fibromyalgia and T. cruzi, was not found.