*2.1. Patient*

*1*

Female, 55 years old, presenting positive serology for CD since 2015, received HT on 2 May as a treatment for Chagas cardiomyopathy (Figure 1A) and underwent immunosuppressive therapy with methylprednisolone and azathioprine. Post-transplantation, she developed pneumonia, treated with meropenem and linezolid, and a remittent *Candida tropicalis* infection, treated with micafungin, with improvement. However, on 29 May, she developed dyspnea and desaturation, with a chest tomography suggestive of COVID-19. Her polymerase chain reaction (PCR) for SARS-CoV-2 was positive on 1 June.

**Figure 1.** Chest X-ray of (**a**) patient 1 from May 2020 and (**b**) patient 2 from June 2015, taken just before heart transplantation, showing the Chagasic cardiomyopathy.

On 3 June, she was transferred to the ICU specialized for treatment of severe SARS-CoV-2 infections. Laboratory analyses then showed that the patient had a reduced number of erythrocytes and hemoglobin level, and these reductions became more accentuated by day 33 in the ICU (Figure 2A,B). On this same day, the number of neutrophils peaked (Figure 2D). From the 4th to the 16th day in ICU, important lymphopenia developed (Figure 2F), resulting in an increase in the neutrophil-to-lymphocyte ratio in the same

period (Figure 2H). Additionally, from the eighth day onward, she presented severe thrombocytopenia that persisted until death (Figure 2I).

Throughout the ICU hospitalization period, there were sustained high levels of creatinine, urea, D-dimer, C-reactive protein (CRP), and lactate dehydrogenase (Figure 2J,K,N,S,W). On the 32nd day, she presented a sharp increase in prothrombin time and activated partial thromboplastin time.

The cardiac function markers of creatine kinase myocardial band (CK-MB) and troponin remained elevated from the first days of ICU admission until death (Figure 2U,X). On the day of admission to the ICU, the N-terminal pro b-type natriuretic peptide (NT pro-BNP) was 70,000 pg/mL (reference value of <125 pg/mL) (Figure 2V). On the third day of hospitalization, NT pro-BNP (155,117 pg/mL) and troponin (0.28 ng/mL, reference value of <0.014 ng/mL) peaked, being related to the period in which she presented signs of graft rejection, which was treated with pulse methylprednisolone, thymoglobulin, and plasmapheresis. In addition, disseminated CMV infection was diagnosed (RT-PCR viral loads of 122 IU/mL on day 10 and 54 IU/mL on day 19 of hospitalization), for which she received ganciclovir.

After 47 days after diagnosis of SARS-CoV-2, the patient died (18 July) due to multiple organ dysfunctions associated with COVID-19.

**Figure 2.** Daily clinical features of patients, from the first day of hospitalization in the ICU until death. Blood levels of ( **A**) erythrocytes, (**B**) hemoglobin, ( **C**) leukocytes, ( **D**) neutrophils, (**E**) eosinophils, (**F**) lymphocytes, ( **G**) monocytes, (**H**) neutrophil-to-lymphocyte ratio, (**I**) platelets, (**J**) creatinine, ( **K**) urea, (**L**) prothrombin time, ( **M**) activated partial thromboplastin time, ( **N**) D-dimer, ( **O**) pH, (**P**) pO2, ( **Q**) pCO2, ( **R**) oxygen peripheral, (**S**) CPR, ( **T**) glucose, ( **U**) CK-MB, ( **V**) NT-proBNP, ( **W**) lactate dehydrogenase, and ( **X**) troponin T. Gray boxes represent the reference values.

### *2.2. Patient 2*

Male, 62 years old, previously diagnosed with CD, received HT on 5 December 2019 as treatment for Chagas cardiomyopathy (Figure 1B). He underwent immunosuppressive therapy with cyclosporine, azathioprine, and prednisone. During postoperative hospitalization he presented Chagas reactivation characterized by skin biopsy and humoral graft rejection, being treated with plasmapheresis and methylprednisolone.

The patient was admitted to the ICU of the Hospital das Clínicas on 8 June, presenting cellulitis, deep vein thrombosis, and Chagas reactivation (a lower limb chagoma). The latter was treated with benznidazol. During hospitalization, he tested positive for PCR of SARS-CoV-2 on 29 June. He developed ARDS and septic and cardiogenic shock, which were the causes of his death.

Throughout the ICU hospitalization period, he maintained decreased levels of erythrocytes, hemoglobin, and lymphocytes (Figure 2A,B,F), as well as a high neutrophil/lymphocyte ratio (Figure 2H). From the 12th day, the number of platelets decreased and continued until the time of death (Figure 2I). The values of creatinine, urea, and glucose also remained high throughout the hospitalization period (Figure 2J,K,T). In addition, disseminated CMV (viral loads of 711 IU/mL detected on the 28th day and 1477 IU/mL on the 35th day of hospitalization) was diagnosed and treated with ganciclovir.

One day before death, the following laboratory parameters peaked: D-dimer (7612 ng/mL FEU, reference value of <500 ng/mL FEU), CRP (280.6 ng/mL, reference value of 0.300 ng/mL), CK-MB (8.38 ng/mL, reference value of 0.10–4.94 ng/mL), NT pro-BNP (55,393 pg/mL), lactate dehydrogenase (1161 U/L, reference value of 135–225 U/L), and troponin (0.701 ng/mL) (Figure 2N,S,U–X).

On 20 July, 36 days after admission to the ICU and 21 days after a positive COVID-19 diagnosis, the patient died.
