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[Acanthamoeba meningoencephalitis: a case in an adolescent female patient with systemic lupus erythematosus]

P Lange1, C Bauer, M Hügens-Penzel

  • 1Institut für Neuropathologie, Justus-Liebig-Universität, Giessen, Deutschland.

Der Pathologe
|September 24, 2008
PubMed

Insights

A rare and fatal Acanthamoeba meningoencephalitis occurred in a 16-year-old girl with systemic lupus erythematosus (SLE). This case highlights diagnostic challenges, especially differentiating Acanthamoeba from macrophages in immunosuppressed patients.

Area of Science:

  • Neuropathology
  • Infectious Diseases
  • Immunology

Background:

  • Meningoencephalitis caused by Acanthamoeba species is a rare, opportunistic infection with a high mortality rate.
  • Systemic lupus erythematosus (SLE) patients on immunosuppressive therapy are vulnerable to opportunistic infections.
  • Accurate diagnosis is challenging due to the rarity and potential misinterpretation of the causative agent.

Observation:

  • A 16-year-old female with SLE on immunosuppression developed fulminant Acanthamoeba meningoencephalitis.
  • Neuropathologic examination revealed hemorrhagic necrotizing lesions, encephalitis, and vasculitis.
  • Acanthamoeba trophozoites in lesions were initially mistaken for macrophages.

Findings:

  • The patient presented with multiple supratentorial and infratentorial hemorrhagic necrotizing lesions.
  • Histopathology showed encephalitis, vasculitis with fibrinoid necrosis, and leptomeningitis.
  • Distinguishing Acanthamoeba from host cells requires careful cytological assessment and specific stains.

Implications:

  • This case underscores the importance of considering Acanthamoeba in the differential diagnosis of severe neurological infections in immunosuppressed patients.
  • Improved diagnostic methods are needed to differentiate Acanthamoeba from host cells in neuropathologic samples.
  • This is the first reported case of Acanthamoeba meningoencephalitis in an SLE patient in Germany.

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