ABC | Volume 113, Nº2, August 2019

Anatomopathological Correlation Pinesi et al. 26-year-old man with congenital chagas disease and heart transplantation Arq Bras Cardiol. 2019; 113(2):286-293 Figure 1 – Electrocardiogram. Sinus rhythm. Left atrial enlargement, right bundle branch block, left anterior hemiblock, premature ventricular contraction, premature atrial contraction. Figure 2 – PA chest x-ray: veil-like opacification of pulmonary bases (pleural effusion), global cardiomegaly. due to hypotension. Orthotopic heart transplantation was performed with no complications on December 6, 2016. The donor was positive for cytomegalovirus. The anatomopathological analysis of the para-aortic lymph nodes revealed reactive lymphadenitis with no granulomas. The post-transplantation electrocardiogram (December 09, 2016) showed low voltage in the frontal plane and end-conduction disorder (Figure 5). The biopsy on December 16, 2016 showed focal mild- degree fiber aggression; focal mild histiocytic proliferation and mild focal lymphocytic infiltrate; there was moderate diffuse edema. Compatible with acute grade 1R cellular rejection (low grade mild rejection). The search for antibody‑mediated rejection by immunohistochemical reaction to complement C4d fraction was negative. The serology was negative for cytomegalovirus; however, molecular biology screening for the parasite was positive since the end of December and viral load reached 47417 U/mL in February 2017, when the patient received ganciclovir for 21 days. 287