Neuropathology of chronic chagasic cardiopathy: A diagnostic reassessment

Intrinsic innervation changes in chronic chagasic cardiopathy long have been regarded as pathognomonic to the disease clinicopathologically and acritically ascribed to incurable “neuronal depletion.” This allegedly diffuse, frequent, and devastating damage to parasympathetic cardiac ganglia was absent in the seven cases we examined and was not demonstrated by reliable neuropathologic diagnosis in former studies from the literature, where the evidence of Terplan nodules, the very hallmark of autonomic neuronal loss, had been lamentably disregarded. Thus, dysautonomic manifestations in chronic chagasic cardiopathy should be attributed to the frequent and widespread finding of neuritic involvement in the severe (auto-) immune fibrosing myocarditis peculiar to the disease.