Capillary malformation as a locus minoris resistentiae for the development of basal cell carcinoma

Abstract

blood samples was positive. She was treated with benznidazole (5 mg/kg/day) for 30 days with total remission of lesions.A 62-year-old male presented with a 10-day history of a painful erythematous-brownish plaque on the left foot (Fig. 1c). Five months previously, he had received a heart transplant due to Chagas cardiomyopathy and was taking tacrolimus (6 mg), mycophenolate mofetil (360 mg) and prednisone (15 mg). A biopsy specimen showed lobular panniculitis with intracellular Trypanosoma cruzi amastigotes (Fig. 1g). Qualitative (PCR) assay for T. cruzi in blood samples was positive. He was treated with benznidazole (5 mg/kg/day) for 60 days with total clearance of the lesion.Reactivation of Chagas disease is a severe complication that can occur in solid organ transplant recipients. 1,2 Most cases are related to kidney or heart transplant, particularly in the first year post-transplant. 3 Liver recipients are at lower risk due to lower doses of immunosuppressants. 5 Indeed, we could not observe any sign of Chagas disease reactivation in our liver recipients, even in those with a diagnosis of chronic Chagas disease. It can manifest with high fever, cardiomyopathy, meningoencephalitis and several painful skin lesions. 2 Mild systemic symptoms were observed in only one patient (case 1); however, all of them developed painful panniculitis lesions.Diagnosis can be made through parasitaemia, histopathological exam, immunohistochemistry and/or PCR. 3,4 In our patients, the diagnosis was done through histopathological analysis, immunohistochemistry and qualitative PCR for T. cruzi in blood samples. Treatment can be nifurtimox or benznidazole. [1][2][3][4][5] Our patients showed good tolerability to benznidazole with remission of lesions.In endemic areas of Chagas disease such as Latin America, Chagas disease reactivation must be considered as an important diagnosis in solid organ transplant recipients, since it can cause graft rejection and death. It also should be kept in mind in developed regions such as the United States and Europe because of the immigrants from endemic areas.