title: Acute chagasic myocardiopathy after orthotopic liver transplantation with donor and recipient serologically negative for Trypanosoma cruzi: a case report.
abstract: Chagas disease (American trypanosomiasis) is caused by the protozoan parasite Trypanosoma cruzi. Chagas disease following solid-organ transplantation has occurred in Latin America. This report presents the occurrence of Chagas disease despite negative serological tests in both the donor and the recipient, as well as the effectiveness of treatment. A 21-year-old woman from the state of Sao Paulo (Brazil) underwent cadaveric donor liver transplantation in November 2005, due to cirrhosis of autoimmune etiology. Ten months after liver transplantation, she developed signs and symptoms of congestive heart failure (New York Heart Association functional class IV). The echocardiogram, which was normal preoperatively, showed dilated cardiac chambers, depressed left ventricular systolic function (ejection fraction = 35%) and moderate pulmonary hypertension. Clinical investigation discarded ischemic heart disease and autoimmune and other causes for heart failure. Immuno fluorescence (immunoglobulin M and immunoglobulin G) and hemagglutination tests for T cruzi were positive, and abundant T cruzi amastigotes were readily identified in myocardial biopsy specimens. Treatment with benznidazole for 2 months yielded an excellent clinical response. At the moment of submission, the patient remains in functional class I. This case highlighted that more appropriate screening for T cruzi infection is mandatory in potential donors and recipients of solid-organ transplants in regions where Chagas disease is prevalent. Moreover, it stressed that this diagnosis should always be considered in recipients who develop cardiac complications, since negative serological tests do not completely discard the possibility of disease transmission and since good results can be achieved with prompt trypanocidal therapy.
authors.affiliation: Special Liver Transplantation Unit, Department of Surgery and Anatomy, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
authors.forename: F F
authors.initials: FF
authors.lastname: Souza
authors.forename: O
authors.initials: O
authors.lastname: Castro-E-Silva
authors.forename: J A
authors.initials: JA
authors.lastname: Marin Neto
authors.forename: A K
authors.initials: AK
authors.lastname: Sankarankutty
authors.forename: A C
authors.initials: AC
authors.lastname: Teixeira
authors.forename: A L C
authors.initials: AL
authors.lastname: Martinelli
authors.forename: G G
authors.initials: GG
authors.lastname: Gaspar
authors.forename: L
authors.initials: L
authors.lastname: Melo
authors.forename: J F C
authors.initials: JF
authors.lastname: Figueiredo
authors.forename: M M D
authors.initials: MM
authors.lastname: Romano
authors.forename: B C
authors.initials: BC
authors.lastname: Maciel
authors.forename: A D C
authors.initials: AD
authors.lastname: Passos
authors.forename: M A
authors.initials: MA
authors.lastname: Rossi
mesh_terms: D000328:Adult; D000818:Animals; D002598:Chagas Cardiomyopathy / Q000175:diagnosis* / Q000188:drug therapy; D004452:Echocardiography; D017809:Fatal Outcome; D006321:Heart / Q000469:parasitology; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D009593:Nitroimidazoles / Q000627:therapeutic use; D016035:Pancreas Transplantation; D011183:Postoperative Complications / Q000469:parasitology*; D014344:Trypanocidal Agents / Q000627:therapeutic use; D014349:Trypanosoma cruzi / Q000302:isolation & purification*; D018487:Ventricular Dysfunction, Left
chemical_list: D009593:Nitroimidazoles; D014344:Trypanocidal Agents; C009999:benzonidazole