title: Late reactivation of Chagas' disease presenting in a recipient as an expansive mass lesion in the brain after heart transplantation of chagasic myocardiopathy.
abstract: 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.
authors.affiliation: Department of Neurology, São Paulo University School of Medicine, São Paulo, Brazil. bibliotecaneuro@hcnet.usp.br
authors.forename: Paulo Euripedes
authors.initials: PE
authors.lastname: Marchiori
authors.forename: Paula Levatti
authors.initials: PL
authors.lastname: Alexandre
authors.forename: Nise
authors.initials: N
authors.lastname: Britto
authors.forename: Roseli A
authors.initials: RA
authors.lastname: Patzina
authors.forename: A Alfredo
authors.initials: AA
authors.lastname: Fiorelli
authors.forename: Leandro T
authors.initials: LT
authors.lastname: Lucato
authors.forename: Sergio
authors.initials: S
authors.lastname: Rosemberg
authors.forename: Samira L Apostolos
authors.initials: SL
authors.lastname: Pereira
authors.forename: Noedir Groppo
authors.initials: NG
authors.lastname: Stolf
authors.forename: Milberto
authors.initials: M
authors.lastname: Scaff
mesh_terms: 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