Chagas’ disease reactivation with skin symptoms in a patient with kidney transplant

Abstract

Immunodepressed patients in the intermediate phase of Chagas' disease may undergo reactivation of the disease together with atypical symptoms. The case of an immunodepressed kidney transplant patient with reactivation of Chagas' disease with skin symptoms is reported. A 65-year-old man presented with infiltrated erythematous lesions on the anterior aspect of the right thigh of 2 weeks' duration. The lesions later extended to the abdomen, thorax, and lower limbs. In the histologic skin examination, amastigotes and Trypanosoma cruzi trypoamastigotes were observed. A fresh smear showed positive parasitemia. Using the Strout hemoconcentration method, multiple Trypanosoma cruzi trypoamastigotes with motility could be seen. Polymerase chain reaction was positive for Trypanosoma cruzi. An immunofluorescence test was positive (1 : 64) and there was hemoagglutination (1 : 32). Treatment was started with benznidazole, 7 mg/kg/day. The patient did not evolve favorably and died 20 days after hospitalization. Skin lesions may be a manifestation of the reactivation of Chagas' disease in immunosuppressed patients. All patients with positive Chagas' serology who require immunosuppressant drugs should receive specific treatment for Chagas' disease.

Importance of Nonenteric Protozoan Infections in Immunocompromised People

“…In one case, parasitosis of the cervix uteri was observed for an HIVinfected patient, diagnosed by a cervical biopsy (113). Another unusual case was reported for a kidney transplant patient who developed Chagasic skin lesions (216).…”

“…In areas of endemicity, reactivated Chagas' disease may be the first presentation of HIV infection (20), and the lethality of T. cruzi-HIV coinfection is high (369). In regions where the disease is endemic, reactivation of latent Chagas' disease not only occurs in patients infected with HIV (118,201,476,496) but also has been reported for those with leukemia (9) or lymphoma (208) and transplant recipients (8,40,216).…”

Reactivation of Chagas’ disease: cutaneous manifestations in two immunosuppressed patients

“…, and Gallerano et al. , the former being evaluated at the Hospital Italiano of Buenos Aires 3,6,14 . La Forgia et al.…”

Skin and soft tissue infections in the transplant population

“…A case report of a renal transplant recipient in Argentina is a representative example: infi ltrated erythematous lesions on the anterior aspect of the right thigh later extended to the abdomen, thorax, and lower limbs, and a skin biopsy demonstrated T. cruzi amastigotes and trypomastigotes [ 44 ].…”