Acute Chagas disease reactivation (CDR) after cardiac transplantation is a well-known phenomenon in endemic countries of Central and South America and Mexico, but is rare outside of those countries. In this report, we describe a case of a 49-year-old male who presented 25 weeks after heart transplant with clinical features concerning for acute rejection, including malaise, anorexia, weight loss, and fever. His immunosuppression therapy included tacrolimus, mycophenolate, and prednisone. An endomyocardial biopsy revealed lymphocytic and eosinophilic inflammation, myocyte damage, and rare foci of intracellular organisms consistent with Trypanosoma cruzi amastigotes. The patient had no known history of Chagas disease. Upon additional questioning, the patient endorsed bites from reduviid bugs during childhood in El Salvador. Follow-up serum PCR testing was positive for T. cruzi DNA. Tests for other infectious organisms and donor specific antibodies were negative. This case illustrates the striking clinical and histologic similarities between acute cellular rejection and acute CDR with cardiac involvement in heart transplant patients, and thus emphasizes the importance of pre-transplant testing for Chagas in patients with epidemiologic risk factors.

心脏移植后的急性南美锥虫病再激活 (CDR) 在中南美洲和墨西哥的流行国家是众所周知的现象，但在这些国家以外很少见。在本报告中，我们描述了一例 49 岁男性，他在心脏移植 25 周后出现与急性排斥反应有关的临床特征，包括不适、厌食、体重减轻和发烧。他的免疫抑制治疗包括他克莫司、霉酚酸酯和泼尼松。心内膜心肌活检显示淋巴细胞和嗜酸性炎症、肌细胞损伤和罕见的细胞内微生物病灶，与克氏锥虫一致无鞭毛虫。该患者没有已知的南美锥虫病病史。经进一步询问，该患者赞同童年时期在萨尔瓦多被红毒蝽咬伤。后续血清 PCR 检测对T. cruzi DNA 呈阳性。其他传染性微生物和供体特异性抗体的检测结果为阴性。该病例说明了急性细胞排斥反应与心脏移植患者心脏受累的急性 CDR 之间的显着临床和组织学相似性，因此强调了在具有流行病学危险因素的患者中对恰加斯进行移植前检测的重要性。