DISSEMINATED CHAGAS DISEASE REACTIVATION FOLLOWING REJECTION TREATMENT IN A HEART TRANSPLANT RECIPIENT

We report a case of disseminated reactivation of Chagas disease in a 57-year-old woman, heart transplant recipient. Heart transplant was performed in 2017 due to severe cardiac dysfunction secondary to Chagas disease. Seven years after the procedure, she was admitted due to reduced ejection fraction and suspected graft rejection. Myocardial biopsy performed one month prior to admission showed grade 1 rejection, with no parasites detected on histopathology. Rejection treatment consisted of pulse corticosteroid therapy and thymoglobulin. Two weeks after pulse therapy, she developed disorientation, decreased level of consciousness, and difficult-to-control seizures. Cranial CT showed no significant acute changes. Lumbar puncture revealed normal opening pressure and isolated hyperproteinorrachia. Due to persistence of neurological symptoms, a second lumbar puncture was performed one week later, and microscopic examination of the slide identified a motile flagellated protozoan compatible with Trypanosoma cruzi in the CSF. On the same day and in subsequent days, the protozoan was also observed in peripheral blood. Quantitative polymerase chain reaction (qPCR) for T. cruzi was positive in CSF and blood, confirming disseminated reactivation of Chagas disease. Benznidazole treatment was started, but the patient died five days later. This case underscores the importance of investigating Chagas disease reactivation in heart transplant recipients with signs of graft dysfunction, highlighting the relevance of sensitive diagnostic methods such as qPCR in peripheral blood, which could be incorporated into myocardial biopsy analysis. We highlight the need for studies assessing the benefit of antiparasitic treatment in patients with Chagas disease who are candidates for heart transplantation, given the prolonged immunosuppression to which they will be subjected.