Under Our Very Eyes

This Clinical Problem-Solving case chronicles the diagnostic challenges surrounding a 64-year-old heart transplant recipient who developed persistent fever, rash, and neurologic symptoms. The patient's post-transplant course was complicated by multiple negative infectious workups, empiric therapy, and neuroimaging suggestive of leukoaraiosis. Only after a peripheral-blood smear revealed extracellular parasites was a diagnosis of acute Trypanosoma cruzi infection Chagas disease, established, likely transmitted via the donor heart. The parasite was confirmed in both blood and CSF, and the patient was treated with benznidazole. Despite parasitologic response, he succumbed to multiorgan failure. The article underscores the importance of considering donor-derived infections and highlights the diagnostic yield of traditional smear microscopy when modern tools fail.

This Clinical Problem-Solving case chronicles the diagnostic challenges surrounding a 64-year-old heart transplant recipient who developed persistent fever, rash, and neurologic symptoms. The patient's post-transplant course was complicated by multiple negative infectious workups, empiric therapy, and neuroimaging suggestive of leukoaraiosis. Only after a peripheral-blood smear revealed extracellular parasites was a diagnosis of acute Trypanosoma cruzi infection Chagas disease, established, likely transmitted via the donor heart. The parasite was confirmed in both blood and CSF, and the patient was treated with benznidazole. Despite parasitologic response, he succumbed to multiorgan failure. The article underscores the importance of considering donor-derived infections and highlights the diagnostic yield of traditional smear microscopy when modern tools fail.