Late reactivation of Chagas' disease presenting in a recipient as an expansive mass lesion in the brain after heart transplantation of chagasic myocardiopathy.
BACKGROUND
Chagas' disease is endemic in many Latin American countries. In the last decades, millions of people from these countries have migrated to the United States, changing the scenario of acute Chagas' disease associated with blood transfusion in North America.


RESULTS
We report the case of a chagasic patient who developed intracranial hypertension and focal neurologic signs 7 months after heart transplantation. Immunosuppression after transplantation was achieved with prednisone, cyclosporine A, and mycophenolate mofetil. Cranial magnetic resonance imaging revealed a right temporoparietal mass lesion with surrounding edema. Trypanosoma cruzi was observed in the cerebrospinal fluid by Giemsa method, and autopsy disclosed a cerebral chagoma with amastigote forms of T cruzi, with neither associated myocarditis nor systemic infection.


CONCLUSIONS
In chagasic patients who undergo heart transplantation and immunosuppression, the risk of late reactivation of Chagas' disease by means of an isolated cerebral mass lesion must be considered.
Marchiori
Paulo Euripedes
PE
Department of Neurology, São Paulo University School of Medicine, São Paulo, Brazil. bibliotecaneuro@hcnet.usp.br
Alexandre
Paula Levatti
PL
Britto
Nise
N
Patzina
Roseli A
RA
Fiorelli
A Alfredo
AA
Lucato
Leandro T
LT
Rosemberg
Sergio
S
Pereira
Samira L Apostolos
SL
Stolf
Noedir Groppo
NG
Scaff
Milberto
M
D000818:Animals; D001921:Brain / Q000469:parasitology / Q000473:pathology; D002598:Chagas Cardiomyopathy / Q000601:surgery*; D014355:Chagas Disease / Q000150:complications* / Q000175:diagnosis*; D004660:Encephalitis / Q000175:diagnosis* / Q000209:etiology*; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D014349:Trypanosoma cruzi / Q000472:pathogenicity