Neurochagas: A Rare Case Of Reactivation Of Chagas Disease After Heart Transplantation

Introduction Chagasic cardiomyopathy is considered the most aggressive etiology of heart failure (HF). There is no specific etiological treatment capable of reversing the evolution of this disease and the heart transplantation (HT) is the main treatment. Reactivation of Chagas disease (CD) has different clinical presentations. Neurological manifestations are rare and other differential diagnoses are more frequent in the Central Nervous System (CNS) in the context of immunosuppression, such as PRESS syndrome, primary CNS lymphoma, neurotoxoplasmosis, neurocriptococcosis and progressive multifocal leukoencephalopathy (LEMP).This study reports a rare case of reactivation of CD in the CNS. Case Report CPN, 48 years old, male, with chagasic cardiomyopathy with EF of 23%, developed advanced HF and underwent bicaval orthotopic HT.The Immunosuppression therapy used was: cyclosporine, azathioprine, prednisone. One month after HT, the patient presented ventricular dysfunction (EF: 40%). The endomyocardial biopsy revealed 2 R cell rejection and he underwent pulse therapy with methylprednisolone. Ventricular function was then recovered. During hospitalization, he presented generalized tonic-clonic seizure (GTCS), controlled with anticonvulsants. CT and MRI of the skull were suggestive of PRESS After 3 weeks, the patient returned with GTCS, associated with delirium, fever, dysarthria and left hemiparesis, and CNS infection was suspected. Cerebrospinal fluid was collected and antibiotics and antiviral drugs were started. In view of the presence of CD in the patient, CD reactivation was suspected in the CNS. This hypothesis was confirmed by direct research in the CSF of trypomastigotes, which confirmed a rare case of neurochagoma. Summary The early diagnosis of reactivation of CD in immunosuppressed is important. High suspicion based on clinical and epidemiological findings is essential, as early treatment will make an important impact in reducing mortality.