Reactivation of Tumor-like Chagas Disease in the Central Nervous System in Cardiac Transplant Patients: A Case Series and Literature Review

Abstract

Introduction Chagas disease is an important public health problem in Latin American countries, affecting ∼ 6 million people within the region. In patients with chronic Chagas disease who undergo some type of immunosuppression reactivation of the acute form may occur, and manifestations involve many organs, including the central nervous system. Tumor-like brain reactivations are well described in patients with acquired immunodeficiency syndrome; however, this is a very rare event among Chagasic patients immunosuppressed after a heart transplantation.

Case Report We describe three cases of cardiac transplant patients who had a tumor-like intracranial lesion, whose biopsies were compatible with Chagas disease. All 3 patients were treated with benznidazole, and 2 of them presented parameters of cure after 60 days of treatment, while 1 required a 2^nd cycle of treatment.

Discussion A tumor-like Chagas disease reactivation in the central nervous system may happen in heart-transplant patients and, due to the multiple differential diagnoses, we believe that brain biopsies should be considered when feasible.

Resumo

Introdução A doença de Chagas é um problema de saúde pública relevante nos países da América Latina, afetando aproximadamente 6 milhões de pessoas na região. Em pacientes com a forma crônica da doença submetidos a algum tipo de imunossupressão, a reativação da forma aguda pode ocorrer e cursar com manifestações que envolvem vários órgãos, incluindo o sistema nervoso central. A reativação cerebral pseudotumoral é bem descrita em pacientes imunossuprimidos pela síndrome de imunodeficiência adquirida; contudo, é um evento raro entre os pacientes imunossuprimidos após transplante cardíaco.

Relato de caso São relatados três casos de transplantados cardíacos que apresentavam uma lesão tumoral intracraniana, cujas biópsias eram compatíveis com a doença de Chagas. Todos os 3 pacientes foram tratados com benznidazol, e 2 deles apresentaram parâmetros de cura após 60 dias de tratamento, enquanto 1 exigiu um 2° ciclo de tratamento.

Discussão A reativação pseudotumoral da doença de Chagas no sistema nervoso central pode acontecer em pacientes submetidos ao transplante cardíaco e, devido aos múltiplos diagnósticos diferenciais, acreditamos que a biópsia cerebral deve ser considerada quando viável.

Keywords

Chagas disease - central nervous system diseases - heart transplantation - immunosuppression therapy

Palavras-chave

doença de Chagas - doenças do sistema nervoso central - transplante de coração - imunossupressão

^* Institution name where the study took place: Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil

Publication History

Received: 06 June 2022

Accepted: 21 June 2022

Article published online:
17 November 2023

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