Trypanosoma cruzi retinitis following donor-derived Chagas disease after heart transplantation

Donor-derived Trypanosoma cruzi infection is a recognized complication of solid organ transplantation, but ocular involvement has never been reported. We described a case of necrotizing retinitis due to T. cruzi in a heart transplant recipient. A 62-year-old man developed unexpected donor-derived Chagas disease 3 months posttransplant and completed a 12-week course of nifurtimox with near-complete clearance of parasitemia. Thirty-eight days after nifurtimox discontinuation, he presented with progressive unilateral vision loss and clinical findings consistent with acute retinal necrosis. Vitreous biopsy with pan-pathogen polymerase chain reaction was negative for viral etiologies but confirmed T. cruzi. Despite systemic benznidazole therapy and clearance of blood parasitemia, intraocular disease progressed, ultimately attempting a salvage adjunctive intravitreal therapy with voriconazole. Ocular inflammation improved, but vision remained limited to light perception. This case underscores the need for continued clinical vigilance for late complications of Chagas disease in transplant recipients. Universal screening for donors with T. cruzi should be considered in future practice, pending the identification of the most appropriate assay, improved accessibility to such assays, and logistical challenges faced by individual organ procurement organizations.