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Fatal granulomatous amoebic meningoencephalitis due to Balamuthia mandrillaris

Istvan Bodi1, Neelanjana Dutt, Timothy Hampton

  • 1Department of Clinical Neuropathology, King's College Hospital, 1st Floor Academic Neuroscience Building, Denmark Hill, London SE5 9RS, UK. Istvan.Bodi@kch.nhs.uk

Pathology, Research and Practice
|August 5, 2008
PubMed

Insights

Rare and fatal amoebic infections of the central nervous system (CNS) are caused by Balamuthia mandrillaris. This case highlights granulomatous amoebic meningoencephalitis (GAM) presenting with skin lesions and neurological symptoms.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Pathology

Background:

  • Amoebic infections of the central nervous system (CNS) are exceptionally rare and typically lead to fatal outcomes.
  • Granulomatous amoebic meningoencephalitis (GAM) is a severe CNS infection.
  • Balamuthia mandrillaris is an opportunistic free-living amoeba that can cause GAM.

Observation:

  • A 33-year-old male presented with confusion and multifocal brain lesions following a prior elbow injury and subsequent skin lesions.
  • Skin biopsy revealed amoebic trophozoites within granulomatous inflammation.
  • Despite medical intervention, the patient's condition rapidly worsened, leading to death.

Findings:

  • Post-mortem examination confirmed widespread hemorrhagic and necrotic brain lesions, consistent with granulomatous amoebic meningoencephalitis (GAM).
  • Histological analysis identified amoebic trophozoites and cysts.
  • Cultures confirmed Balamuthia mandrillaris as the causative agent.

Implications:

  • GAM caused by B. mandrillaris can affect individuals of any age, irrespective of immunosuppression status.
  • The infection has a worldwide distribution and typically follows a subacute, fatal course.
  • Hematogenous dissemination from chronic skin or lung lesions is a likely route of CNS involvement.

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