Marchiori Paulo Euripedes, Alexandre Paula Levatti, Britto Nise, Patzina Roseli A, Fiorelli A Alfredo, Lucato Leandro T, Rosemberg Sergio, Pereira Samira L Apostolos, Stolf Noedir Groppo, Scaff Milberto
Department of Neurology, São Paulo University School of Medicine, São Paulo, Brazil.
J Heart Lung Transplant. 2007 Nov;26(11):1091-6. doi: 10.1016/j.healun.2007.07.043. Epub 2007 Oct 24.
Chagas' disease is endemic in many Latin American countries. In the last decades, millions of people from these countries have migrated to the United States, changing the scenario of acute Chagas' disease associated with blood transfusion in North America.
We report the case of a chagasic patient who developed intracranial hypertension and focal neurologic signs 7 months after heart transplantation. Immunosuppression after transplantation was achieved with prednisone, cyclosporine A, and mycophenolate mofetil. Cranial magnetic resonance imaging revealed a right temporoparietal mass lesion with surrounding edema. Trypanosoma cruzi was observed in the cerebrospinal fluid by Giemsa method, and autopsy disclosed a cerebral chagoma with amastigote forms of T cruzi, with neither associated myocarditis nor systemic infection.
In chagasic patients who undergo heart transplantation and immunosuppression, the risk of late reactivation of Chagas' disease by means of an isolated cerebral mass lesion must be considered.
恰加斯病在许多拉丁美洲国家呈地方性流行。在过去几十年中，数百万来自这些国家的人移民到了美国，改变了北美与输血相关的急性恰加斯病的情况。
我们报告了一例恰加斯病患者的病例，该患者在心脏移植7个月后出现颅内高压和局灶性神经体征。移植后通过泼尼松、环孢素A和霉酚酸酯进行免疫抑制。头颅磁共振成像显示右侧颞顶叶有占位性病变并伴有周围水肿。通过吉姆萨染色法在脑脊液中观察到克氏锥虫，尸检发现有含克氏锥虫无鞭毛体形式的脑恰加斯瘤，既无相关心肌炎也无全身感染。
对于接受心脏移植并进行免疫抑制的恰加斯病患者，必须考虑通过孤立性脑占位性病变导致恰加斯病晚期再激活的风险。
