title: 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.
authors.affiliation: Department of Dermatology, Hospital Córdoba, and Department of Pathology, Reina Fabiola Clinic, Catholic University of Córdoba, Córdoba, Argentina.
authors.forename: Verónica
authors.initials: V
authors.lastname: Gallerano
authors.forename: Javier
authors.initials: J
authors.lastname: Consigli
authors.forename: Susana
authors.initials: S
authors.lastname: Pereyra
authors.forename: Susana
authors.initials: S
authors.lastname: Gómez Zanni
authors.forename: Cristian
authors.initials: C
authors.lastname: Danielo
authors.forename: Rafael H
authors.initials: RH
authors.lastname: Gallerano
authors.forename: Andrés
authors.initials: A
authors.lastname: Guidi
mesh_terms: D000368:Aged; D000818:Animals; D014355:Chagas Disease / Q000209:etiology* / Q000473:pathology; D017809:Fatal Outcome; D006801:Humans; D016867:Immunocompromised Host; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D009894:Opportunistic Infections / Q000209:etiology*; D012008:Recurrence; D012876:Skin Diseases, Parasitic / Q000209:etiology* / Q000473:pathology; D014349:Trypanosoma cruzi / Q000302:isolation & purification*