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September 2004: a 6-year-old girl with headache and stiff neck

Qing Li, Xiao-He Yang, Jiang Qian

    Brain Pathology (Zurich, Switzerland)
    |March 23, 2005
    PubMed

    Insights

    A fatal case of Balamuthia mandrillaris infection causing granulomatous amebic meningoencephalitis (GAE) in a child highlights the importance of considering amebic parasites in CNS lesions.

    Area of Science:

    • Neurology
    • Infectious Diseases
    • Parasitology

    Background:

    • Free-living amebas, including Balamuthia mandrillaris, are known pathogens causing central nervous system (CNS) infections.
    • Granulomatous amebic encephalitis (GAE) is a rare but severe CNS infection.

    Observation:

    • A previously healthy 6-year-old girl presented with headache and stiff neck, initially treated as a brain abscess.
    • Imaging revealed a ring-enhancing lesion, and initial biopsy showed necrosis and granulomatous inflammation.
    • A second biopsy identified viable Balamuthia mandrillaris trophozoites, predominantly in perivascular spaces.

    Findings:

    • Immunofluorescence confirmed the causative agent as Balamuthia mandrillaris.
    • The infection led to fatal granulomatous amebic meningoencephalitis.
    • Trophozoites were associated with neutrophils, macrophages, and eosinophils in the brain tissue.

    Implications:

    • Early diagnosis of GAE requires a high index of suspicion.
    • Amebic infection should be considered in the differential diagnosis of CNS granulomatous lesions, especially with necrosis.
    • Thorough examination for amebic parasites is crucial in relevant pathological findings.

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