A case of Chagas’ disease panniculitis after kidney transplantation

Abstract

Chagas' disease carries high morbidity and mortality due to acute parasitemia or cardiac, digestive, cutaneous or neurologic chronic lesions. Latin American countries have the majority of infected or at risk people. Transplanted patients using immunosuppressive agents may develop severe and even fatal forms of the disease. The available treatment causes frequent severe side-effects. A 59 years-old woman with end stage renal disease and positive serology for Chagas` disease, but without any clinical manifestation of this pathology, underwent kidney transplantation from a cadaveric donor and displayed three months later a thigh panniculitis from which a biopsy unveiled amastigote forms of Trypanosoma cruzi. The skin lesions disappeared following treatment with benzonidazole, but the drug was discontinued due to severe pancytopenia. Along with this, infection with E. faecalis and cytomegalovirus were treated with vancomicin and ganciclovir. The patient kept very well afterwards, with no new skin lesions and with good graft function. One year and three months after the transplant, she had an emergency surgery for an aortic dissecting aneurysm. Irreversible shock and death occurred in the immediate post-surgical period. It was not possible to establish or to rule out a relationship between the trypanosomiasis and the aortic lesions. Chagas` disease must be remembered in differential diagnosis of several clinical situations in transplant patients, mainly in endemic areas. The treatment can yeld good clinical response, but serious side-effects from the drugs may ensue. More effective and better tolerated options are in need for treatment or prophylaxis.

Parasitic Infections Associated with Unfavourable Outcomes in Transplant Recipients

“…Chagas disease (American trypanosomiasis) is a chronic systemic disease caused by protozoan parasite Trypanosoma cruzi . Chagas disease carries high morbidity and mortality in endemic countries [ 25 , 26 ]. It is estimated that there are 10 million people infected with T. cruzi , most of them living in Latin America [ 26 ].…”

Prevalence of Chagas Disease among Solid Organ–Transplanted Patients in a Nonendemic Country

“…Moreover, in addition to common clinical presentation of Chagas disease reactivation (myocarditis and meningoencephalitis), it may present with skin lesions such as panniculitis and erythema nodosum-like lesions. 7,8,[25][26][27] The migration flows from rural endemic areas to urban areas and nonendemic areas have contributed that Chagas disease patients increasingly participate in transplantation programs. 2 Furthermore, since Chagas disease is usually asymptomatic, patients awaiting organ transplantation are often unaware of the diagnosis.…”

Chagas Disease, Leishmaniasis, and Malaria in Solid Organ Transplant Recipients

“…A parasitological response is generally rapidly achieved as documented by the absence of parasites by Strout analysis after one week of treatment, although using more sensitive methods such as kDNA PCR a negative results is observed between 1 and 2 weeks after treatment [26,43]. Clinical manifestations include febrile illness, new onset of painful wine-colored nodules (metastatic chagomas) which can ulcerate, erythematous plaque or panniculitis, acute myocarditis, or tumorlike brain lesions mimicking toxoplasmosis or neoplastic processes [53][54][55][56][57][58][59]. Myocarditis and meningoencephalitis can run an aggressive course, rapidly leading to the death of the patients [58][59][60].…”