Skin lesions, malaise, and heart failure in a renal transplant recipient

A male Caucasian patient developed nodular erythematous skin lesions, malaise, and clinical signs of progressive heart failure 4 months after renal transplantation. Bronchoscopy with bronchoalveolar lavage performed for a small infiltrate seen on a computed tomography scan revealed Trypanosoma, whic...

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Bibliographic Details
Published in:Transplant infectious disease 2012-08, Vol.14 (4), p.391-397
Main Authors: Kocher, C., Segerer, S., Schleich, A., Caduff, R., Wyler, L.G., Müller, V., Beck, B., Blum, J., Kamarachev, J., Mueller, N.J.
Format: Article
Language:English
Subjects:
Adult
Antibodies, Protozoan - blood
Chagas Cardiomyopathy - complications
Chagas Cardiomyopathy - parasitology
Chagas Cardiomyopathy - physiopathology
Chagas Disease - complications
Chagas Disease - parasitology
Chagas Disease - physiopathology
Chagas' disease
Fatal Outcome
Heart Failure - etiology
Humans
kidney transplantation
Kidney Transplantation - adverse effects
Male
Myocarditis - complications
Myocarditis - parasitology
Parasitemia - complications
Parasitemia - parasitology
reactivation
Skin - parasitology
Skin - pathology
Skin Diseases, Parasitic - parasitology
Skin Diseases, Parasitic - physiopathology
Trypanosoma
Trypanosoma cruzi
Trypanosoma cruzi - genetics
Trypanosoma cruzi - immunology
trypanosomiasis
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Summary:A male Caucasian patient developed nodular erythematous skin lesions, malaise, and clinical signs of progressive heart failure 4 months after renal transplantation. Bronchoscopy with bronchoalveolar lavage performed for a small infiltrate seen on a computed tomography scan revealed Trypanosoma, which had at this point not been suspected as a cause. Parasitemia was present, and reactivation rather than transmission of Chagas' disease was established by performing polymerase chain reaction and serology in the donor and recipient. Treatment with benznidazole and allopurinol successfully reduced parasitemia, but the clinical course was fatal owing to progression of severe myocarditis. The patient had never lived in an endemic area, but had an extensive travel history in South America. The last visit was more than 5 years before transplantation. In non‐endemic countries (United States, Europe), reactivation after transplantation has only been very rarely reported. Given the rising numbers of transplantations in patients with a migration background and extensive travel histories, specific screening procedures have to be considered.
ISSN:1398-2273
1399-3062
DOI:10.1111/j.1399-3062.2012.00731.x