Chagas disease reactivation after autologous stem cell transplant. Case report and literature review

Chagas disease is an endemic parasitic infection in Latin America transmitted by triatomines. It is associated with risk factors such as poverty and rurality. After acute infection, a third of patients will present target organ involvement (heart, digestive tract, central nervous system). The remaining two thirds remain asymptomatic throughout their life. Pharmacological immunosuppression breaks the balance between the immune system and the parasite, favoring its reactivation. We present the case of a 58-year-old man from a Colombian rural area with a diagnosis of multiple myeloma refractory to the first line of treatment who required a new chemotherapy scheme and consolidation with autologous stem cell transplant. During the post-transplant period, he suffered from febrile neutropenia. Initial microbiological studies were negative. Peripheral blood smear was performed with evidence of trypomastigotes in blood. With a diagnosis of acute Chagas disease in a post-transplant patient, benznidazole was started. The evolution of the patient was satisfactory. Positive serology prior to transplantation makes it necessary to rule out reactivation of pathology in the setting of febrile neutropenia. More studies are required to determine tools that allow estimating the probability of reactivation of the disease according to which the best scenario in relation to the cost-risk-benefit of prophylactic therapy can be defined.