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 4 – Magnetic resonance image: transmural, mid-wall and subepicardial late gadolinium enhancement not involving subendocardium. Figure 3 – X-rays: global cardiomegaly, larger increase of the right ventricle. The echocardiogram performed in February 2017 was normal, except for an increase in the left atrium, whereas the one performed in March showed all measures within the normal range. In a biopsy carried out in March 2017, moderate and focal fiber aggression, moderate diffuse proliferation, moderate focal lymphocytic infiltrate and mild diffuse edema were observed. Amastigote nests were observed inside the myocytes, with protozoal myocarditis. This biopsy was suggestive of Chagas' disease reactivation, with moderate mononuclear myocarditis. Kinetoplasts were observed in the parasites and the immunohistochemistry was positive for Trypanosoma cruzi antigens. Benznidazole was then prescribed. A biopsy carried out in September 2017 disclosed acute grade 2R cellular rejection (moderate rejection, intermediate grade). Both histological and immunohistological analysis were negative for Trypanosoma cruzi . The serology for Chagas' disease was negative in November 2017. At an outpatient consultation on May 3 2019, the patient was asymptomatic and the physical examination was normal. Clinical aspects Chagas' disease was first described by Brazilian physician and scientist Carlos Chagas in 1909. 1 This multifaceted disease is caused by the protozoan Trypanosoma cruzi , which can be 288