Abstract 15242: Donor-Derived Chagas Disease Masquerading as Acute Heart Transplant Rejection

Abstract

Introduction: Although Chagas disease affects over 300,000 residents in the US, donor-derived Trypanosoma cruzi transmission is an uncommon complication after heart transplantation. We present a case of post-transplant Chagas cardiomyopathy. Results: A 68 year old male with history of heart failure with reduced ejection fraction secondary to ischemic cardiomyopathy, status post HeartMate III and subsequent orthotopic heart transplantation from a Hispanic donor, initially presented four months after transplant for routine right heart catheterization. Endomyocardial biopsy showed grade 2R acute cellular rejection. Patient was treated with IV steroids and discharged. One month later, he presented with one week of fevers, malaise, non-tender erythematous patches on his upper body and hemorrhagic bullae on his buccal mucosa. Initial workup was notable for pancytopenia with WBC 1.3 x10e9/L, hemoglobin 10.3g/dL, and platelets 77 x10e9/L, troponin 3.47 ng/mL, NT-proBNP 11,331 pg/mL, and new right bundle branch block on electrocardiogram. Cardiac MRI showed extensive multifocal late gadolinium enhancement and pericardial exudates, suggestive of atypical infection. Despite treatment with Filgrastim and IVIG, the patient progressed to cardiogenic shock complicated by complete heart block requiring transvenous pacing, and ventricular tachycardia. On hospital day 5, a peripheral smear confirmed Trypanosoma cruzi with high parasite burden and amastigotes were visualized on a shave biopsy of his rash. Patient was initiated on Benznidazole. He was treated in the intensive care unit, where his course was further complicated by recurrent VT, for which he received an implantable cardiac defibrillator, and renal failure requiring hemodialysis. Conclusions: We present a case of suspected donor-derived Chagas Disease. In retrospect, this patient’s initial episode of acute rejection was most likely due to Chagas Disease. Due to increasing globalization of endemic diseases and life-threatening complications associated with this disease, a high index of suspicion is required to diagnose and treat T. cruzi after heart transplantation in the setting of non-specific symptoms.