Cutaneous Reactivation of Trypanosoma cruzi in a Dual Organ Transplant Recipient: A Case Report

Chagas disease, caused by Trypanosoma cruzi, is a leading cause of nonischemic cardiomyopathy in endemic regions and may reactivate in immunocompromised patients, most commonly within the first year following transplantation. We report a case of cutaneous T. cruzi reactivation in a 39-year-old woman with prior heart and kidney transplantation who had lifelong residence in Los Angeles and only limited childhood travel to an endemic area in Mexico. She presented with painful erythematous plaques on her right shin initially treated with systemic antibiotics for presumed cellulitis without improvement. Diagnosis was established by skin biopsy, despite previously negative endomyocardial biopsies, as well as positive serologies and elevated quantitative polymerase chain reaction levels. Notably, reactivation occurred approximately 5 years after transplantation in the setting of dual organ transplantation and intensified immunosuppression, far beyond the typical high-risk period. This case adds to the growing body of literature on the specific cutaneous manifestations that can be a clue to diagnosing Chagas reactivation. It also underscores the importance of maintaining clinical suspicion for Chagas disease in a patient with otherwise unexplained cardiomyopathy, even with limited epidemiologic exposure.