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Chagas disease has emerged as a global public health issue, particularly regarding organ transplantation due to the exponential growth of chronic kidney disease. This has led to the utilization of organs from donors with positive serology, employing established protocols for monitoring parasite reactivation based on scientific evidence.
A 66-year-old male patient with a history of diabetes (5 years), hypertension (15 years), and one year of hemodialysis for end-stage renal disease. He received his first renal transplant in 2016 from a deceased donor with full house compatibility (0-0-0), positive for Chagas, Toxoplasmosis, CMV, and negative for other serologies. Induction therapy included monoclonal antibody, steroids, mycophenolate, and tacrolimus. Weekly Strout tests were negative. On the 15th post-transplant day, the patient developed disseminated papulo-erythematous lesions on the forehead and scalp. Parasite testing at this stage yielded negative results. Lesions improved, and the patient was discharged with maintenance therapy: Tacrolimus 10 mg, Mycophenolate sodium 1440 mg, and tapered prednisone at 8 mg by month.
At the 6th post-transplant month, the patient presented with skin lesions, predominantly an asymptomatic rash on the trunk, mild pruritus, and petechiae on lower limbs and forearms. Afebrile and in good general health. Platelet decrease and lymphocytosis were observed. Strout and PCR tests were negative.
By the 8th post-transplant month, the patient continued to experience an asymptomatic morbiliform maculopapular rash, pruritus, and petechiae on the trunk and hands. Purpuric lesions on the lower limbs were also noted. Strout and PCR tests were positive. Chagas (indirect hemagglutination) was positive with a quantitative Chagas level of 1/128. Positive Elisa for Toxoplasmosis (CMIA) IgG was non-reactive, while IgM was positive.
Two skin biopsies were performed: one on the left leg showed leucocytoclastic vasculitis, and the other on the trunk displayed infectious dermatitis, likely parasitic. Treatment with Benznidazole at 400 mg/day commenced, leading to clinical improvement.
With the escalating demand for organs and the persistence of this endemic zoonosis in Latin American countries, meticulous patient examinations for recipients of organs from Chagas positive donors are crucial for timely diagnosis and to prevent multi-organ involvement. It's important to note that parasitemia tests may not always precede clinical manifestations, as seen in this report, where the patient exhibited the disease before positive Strout and PCR results.