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

Abstract

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.

Cutaneous presentation of Chagas' disease reactivation in a heart‐transplant patient

“…1,6,9 This therapy can also have serious consequences, such as the reactivation of Chagas' disease in patients with its chronic form. 2,6,7 The next case illustrates this unusual form of reactivation in a heart-transplant patient on immunosuppressive drugs, characterized by skin lesions of erythema nodosum.…”

“…Chagas' disease, endemic in Latin America, is an infection caused by the flagellate protozoan Trypanosoma cruzi. [1][2][3][4] A third of the patients of the indeterminate phase of Chagas' disease will evolve to chronic symptomatic disease one or two decades after the initial infection. Cardiomyopathy is the most common manifestation.…”

“…[1][2][3] Studies with allopurinol and itraconazole also presented good results, but they do not ensure prevention of new episodes of reactivation. 1,2,8 In conclusion, this is a rare and unusual case report of CD reactivation after heart transplant, manifested by cutaneous-only lesions that was promptly diagnosed and successfully treated. It is recommended that dermatologists be aware of skin lesions in transplanted patients in endemic countries of CD.…”

“…Metalloproteinase-9 (MMP-9), produced in multinuclear giant cells, 1 is considered a subclass of the MMPs (a family of zinc-dependent endopeptidases), and is involved in processes that occur during cutaneous wound healing such as, inflammation matrix remodelling and epithelization. 2 The activity of MMP-9 has been shown to be critical for several of these processes in the content of pathological conditions, such as hypertrophic scars 3,4 and keloids. 4,5 In addition, a pyrimidine analogue with antimetabolite activity, 5-fluorouracil, when given intralesionally, is an alternative therapy for keloids.…”

A Case of Possible Chagas Transmission by Blood Transfusion in Switzerland

“…Nevertheless, the patient died 7 days after hospitalization due to cardiogenic shock and multi-organ failure. The autopsy showed generalized myocarditis with infiltration of T. cruzi as well as perforated sigma diverticulitis [22]. It had been assumed that the patient was infected with T. cruzi during extensive travelling in South America 5 years before kidney transplantation.…”