Unexpected case of chagas disease reactivation in endomyocardial biopsy for evaluation of cardiac allograft rejection.
Cardiovasc Pathol
; 57: 107394, 2022.
Article
in En
| MEDLINE
| ID: mdl-34742866
ABSTRACT
Acute Chagas disease reactivation (CDR) after cardiac transplantation is a well-known phenomenon in endemic countries of Central and South America and Mexico, but is rare outside of those countries. In this report, we describe a case of a 49-year-old male who presented 25 weeks after heart transplant with clinical features concerning for acute rejection, including malaise, anorexia, weight loss, and fever. His immunosuppression therapy included tacrolimus, mycophenolate, and prednisone. An endomyocardial biopsy revealed lymphocytic and eosinophilic inflammation, myocyte damage, and rare foci of intracellular organisms consistent with Trypanosoma cruzi amastigotes. The patient had no known history of Chagas disease. Upon additional questioning, the patient endorsed bites from reduviid bugs during childhood in El Salvador. Follow-up serum PCR testing was positive for T. cruzi DNA. Tests for other infectious organisms and donor specific antibodies were negative. This case illustrates the striking clinical and histologic similarities between acute cellular rejection and acute CDR with cardiac involvement in heart transplant patients, and thus emphasizes the importance of pre-transplant testing for Chagas in patients with epidemiologic risk factors.
Key words
Full text:
1
Database:
MEDLINE
Main subject:
Trypanosoma cruzi
/
Chagas Cardiomyopathy
/
Heart Transplantation
/
Chagas Disease
Type of study:
Diagnostic_studies
/
Risk_factors_studies
Limits:
Humans
/
Male
/
Middle aged
Language:
En
Journal:
Cardiovasc Pathol
Journal subject:
ANGIOLOGIA
/
CARDIOLOGIA
/
PATOLOGIA
Year:
2022
Type:
Article