case 2 - kathrin glatz
TRANSCRIPT
• SGPath Slide Seminar 2015/11
Case 2
• Rosmarie Caduff, Institut für Klinische Pathologie, UniversitätsSpital Zürich
Clinics • 73-year old man
• 4 months before renal transplantation
• 1 month before mitral valve clipping
• Progressive malaise, respiratory distress
• Immunosupressive therapy
Clinics • 73-year old man
• 4 months before renal transplantation
• 1 month before mitral valve clipping
• Progressive malaise, respiratory stress
• Immunosupressive therapy
• 2 weeks before admission: skin lesions, histology unspecific inflammation
• Hospital admission: progressive renal graft dysfunction. Biventricular heart
failure. Fever.
• Blood cultures, urine examination, chest RX negative.
• Lung CT with opacity
Clinics • 73-year old man
• 4 months before renal transplantation
• 1 month before mitral valve clipping
• Progressive malaise, respiratory stress
• Immunosupressive therapy
• 2 weeks before admission: skin lesions
• Hospital admission: progressive renal graft dysfunction. Biventricular heart
failure. Fever.
• Blood cultures, urine examination, chest RX negative.
• Lung CT with opacity, lavage, detection of Trypanosoma cruzi
• Antiparasitic treatment
• Progression of hemodynamic instability, cardiogenic shock
Cortex Cortex
Medulla SV40
ptc
ptc
ptc
ptc
C4d negative in
peritubular capillaries
C4d positive in tubular
basement membranes
no microvascular
inflammation
Diagnoses
• Chagas myocarditis
• Renal cortical necrosis, chronic active vascular rejection.
Acute/floride polyomavirus nephropathy
Your diagnoses (heart) 62
• Myocarditis after reactivation of T.c. 2
• Chagas Disease 3
• Myocarditis with T.c. 9
• May be amastigote/T.c. in the heart? 6
• Myocarditis 29
• Ischemia/infarction/hypertrophy 9
• GvHD 3
• Plasmocytoma 1
•
Your diagnoses (kidney) 62
• Cortical necrosis, vascular rejection, BK 1
• Cortical necrosis or rejection or BK 10
• Ischemia/infarction/shock 26
• DIC 6
• Glomerulosclerosis, interstitial Nephritis, Tub.n 6
• Parasitosis, T.c., CMV 5
• No diagnosis for kidney pathology 8
•
Macroscopy (major findings)
• Heart/circulation: weight 568g (normal upper limit 368g), biventricular
hypertrophy and dilatation, scar left lateral. Sclerosis of the coronary arteries
without stenosis. Severe general arteriosclerosis. Thromboses of the right
atrium, right jugular veine, left iliacal veine.
Macroscopy (major findings) • Heart/circulation: weight 568g (normal upper limit 368g), biventricular
hypertrophy and dilatation, scar left lateral. Sclerosis of the coronary arteries
without stenosis. Severe general arteriosclerosis. Thromboses of the right
atrium, right jugular veine, left iliacal veine.
• Lungs: edeme, hemorrhages. Beginning of shock. Bilateral, paracentral,
organized and fresh pulmonary emboli with a wedge shaped hemorrhagic infarct
pleurabased in the right lower lobe. Bilateral pleural effusions.
• Shock necroses in the liver. Acute, abscess forming diverticulitis of the colon
descendens and sigmoideum.
• No metastases from prostate cancer diagnosed 2 years before death.
• Shrunken native kidneys. Necrotic transplant.
Carlos Chagas
Oswaldo Cruz
Trypanosoma cruzi, detected 1909 by Carlos Chagas
N Engl J Med. 2015
N Engl J Med. 2015
Trends Parasitol. 2015
DD Recurrence in our patient
Reactivation of latent disease under immunsuppression
Transmission by kidney transplantation
Transmission by blood transfusions
