Acute Chagasic Myocardiopathy After Orthotopic Liver Transplantation With Donor and Recipient Serologically Negative for Trypanosoma cruzi: A Case Report F.F. Souza, O. Castro-e-Silva, J.A. Marin Neto, A.K. Sankarankutty, A.C. Teixeira, A.L.C. Martinelli, G.G. Gaspar, L. Melo, J.F.C. Figueiredo, M.M.D. Romano, B.C. Maciel, A ¨ .D.C. Passos, and M.A. Rossi ABSTRACT Chagas disease (American trypanosomiasis) is caused by the protozoan parasite Trypano- soma cruzi. Chagas disease following solid-organ transplantation has occurred in Latin America. This report presents the occurrence of Chagas disease despite negative serolog- ical 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 hemag- glutination 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. C HAGAS DISEASE (American trypanosomiasis) is caused by the protozoan parasite Trypanosoma cruzi, which is transmitted mainly by the insects from the Triatominae 1–3 subfamily. Following the so-called “Inicia- tiva del Cone Sur,” which aimed at Chagas disease control, the vectorial and transfusional transmissions were declared extinct in Uruguay (1997), Chile (1999), and Brazil (2005). 4 However, Chagas disease clearly tends to become ubiqui- tous due to migrating currents and to the continuous modification of ecosystems. That can be exemplified through the estimate that at least 100,000 carriers of T cruzi infection may reside in the United State, 5 and also through the recent evidence of Chagas disease in the Amazon region. 6 Clinically, the disease includes two phases: acute and chronic. In the acute phase, the manifestations include characteristic signs in the insect’s sting site and marked symptoms and signs of a systemic infection, such as fever, anorexia, adynamia, malaise, lymph node swelling, hepato- From the Special Liver Transplantation Unit, Departments of Surgery and Anatomy (F.F.S., O.C.e.-S., A.K.S., A.C.T.), Internal Medicine (J.A.M.N., A.L.C.M., G.G.G., L.M., J.F.C.F., M.M.D.R., B.C.M.), Social Medicine (A.D.C.P.), and Pathology (M.A.R.), Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil. Financial support: CNPq, FAPESP, FAEPA, and SUS. Address reprint requests to Orlando de Castro e Silva, Full Professor, Surgery and Anatomy Department from Ribeirão Preto Medical School, Avenida Bandeirantes, 3.900 —CEP 14049-900 Ribeirão Preto—SP—Brasil. E-mail: orlando@fmrp. usp.br © 2008 by Elsevier Inc. All rights reserved. 0041-1345/08/$–see front matter 360 Park Avenue South, New York, NY 10010-1710 doi:10.1016/j.transproceed.2008.02.032 Transplantation Proceedings, 40, 875– 878 (2008) 875