title: A case of Chagas' disease panniculitis after kidney transplantation.
abstract: Chagas' disease carries high morbidity and mortality due to acute parasitemia or cardiac, digestive, cutaneous or neurologic chronic lesions. Latin American countries have the majority of infected or at risk people. Transplanted patients using immunosuppressive agents may develop severe and even fatal forms of the disease. The available treatment causes frequent severe side-effects. A 59 years-old woman with end stage renal disease and positive serology for Chagas` disease, but without any clinical manifestation of this pathology, underwent kidney transplantation from a cadaveric donor and displayed three months later a thigh panniculitis from which a biopsy unveiled amastigote forms of Trypanosoma cruzi. The skin lesions disappeared following treatment with benzonidazole, but the drug was discontinued due to severe pancytopenia. Along with this, infection with E. faecalis and cytomegalovirus were treated with vancomicin and ganciclovir. The patient kept very well afterwards, with no new skin lesions and with good graft function. One year and three months after the transplant, she had an emergency surgery for an aortic dissecting aneurysm. Irreversible shock and death occurred in the immediate post-surgical period. It was not possible to establish or to rule out a relationship between the trypanosomiasis and the aortic lesions. Chagas` disease must be remembered in differential diagnosis of several clinical situations in transplant patients, mainly in endemic areas. The treatment can yeld good clinical response, but serious side-effects from the drugs may ensue. More effective and better tolerated options are in need for treatment or prophylaxis.
authors.affiliation: Hospital Universitário de Santa Maria, Universidade Federal de Santa Maria, Brazil.
authors.forename: Fábio Prestes de
authors.initials: FP
authors.lastname: Campos
authors.affiliation: Hospital Universitário de Santa Maria, Universidade Federal de Santa Maria, Brazil.
authors.forename: Henry Mor
authors.initials: HM
authors.lastname: Pansard
authors.affiliation: Hospital Universitário de Santa Maria, Universidade Federal de Santa Maria, Brazil.
authors.forename: Luiz Cláudio
authors.initials: LC
authors.lastname: Arantes
authors.affiliation: Hospital Universitário de Santa Maria, Universidade Federal de Santa Maria, Brazil.
authors.forename: Arnaldo Teixeira
authors.initials: AT
authors.lastname: Rodrigues
authors.affiliation: Hospital Universitário de Santa Maria, Universidade Federal de Santa Maria, Brazil.
authors.forename: Melissa Falster
authors.initials: MF
authors.lastname: Daubermann
authors.affiliation: Hospital Universitário de Santa Maria, Universidade Federal de Santa Maria, Brazil.
authors.forename: Marcos Felipe
authors.initials: MF
authors.lastname: Azambuja
authors.affiliation: Hospital Universitário de Santa Maria, Universidade Federal de Santa Maria, Brazil.
authors.forename: Laércio Cassol
authors.initials: LC
authors.lastname: Argenta
authors.affiliation: Hospital Universitário de Santa Maria, Universidade Federal de Santa Maria, Brazil.
authors.forename: Luiz Alberto Michet da
authors.initials: LA
authors.lastname: Silva
mesh_terms: D014355:Chagas Disease / Q000150:complications* / Q000188:drug therapy; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D015434:Panniculitis / Q000209:etiology*; D014349:Trypanosoma cruzi
chemical_list: D007166:Immunosuppressive Agents