[Cutaneous acanthamoebiasis in a lung transplant patient]

Cutaneous acanthamoebiasis is a rare opportunistic infection in immunocompromised patients, particularly in HIV infected patients. We report a case of a primary cutaneous Acanthamoeba infection, in a patient with a double lung transplant not infected by the HIV.

A 38 year-old white man, with a double lung transplant 3 years ago, developed a painful fibrinous ulceration of the right foot, with cellulitis. A few days later, two purplish nodules were observed, surrounded by an inflammatory reaction. Histologic examination revealed trophozoite and cyst forms. Therapy was begun with intravenous pentamidine and itraconazole along with topical ketoconazole and chlorhexidine, but was ineffective. Because of the renal toxicity of pentamidine, the patient was treated by dialysis. He died six months after diagnosis of Acanthamoeba infection.

Acanthamoeba, a free-living amoeba is the causative organism of few human diseases. In immunocompromised hosts (particularly HIV infected), besides granulomatous amebic encephalitis, it can provoke some cutaneous lesions such as nodules, pustules, ulcerations... Skin biopsy is diagnostic: numerous amebic trophozoites and cysts are visualized. Recommended treatments are pentamidine, itraconazole and flucytosine. Due to the morbidity and mortality of acanthamoeba infection optimal therapy must be defined.