Psychiatric presentation of human African trypanosomiasis: overview of diagnostic pitfalls, interest of difluoromethylornithine treatment and contribution of magnetic resonance imaging

We report a case of a western African man, residing in France for 4 years, who developed human African trypanosomiasis (HAT) caused by Trypanosoma bru cei gambiense. Diagnosis was made at a late stage of the disease. The disea se was misdiagnosed and untreated for several years because the clinical pr esentation was limited to psychiatric disorders and biological confirmation was difficult. Polysomnographic recordings demonstrated typical alteration s of HAT. Difluoromethylornithine was effective in this late stage of the d isease. Magnetic resonance imaging showed brain edema with demyelination an d associated brain atrophy and abnormal signals in the brainstem and thalam us, both implied in sleep-wake cycle.