Fatal Balamuthia mandrillaris Encephalitis.

Area of Science:

• Neurology
• Infectious Diseases
• Pathology

Background:

• Balamuthia mandrillaris is a rare protozoan pathogen causing granulomatous meningoencephalitis (GAM), a severe central nervous system infection with high mortality.
• GAM typically affects immunocompromised individuals, but can also occur in immunocompetent hosts.

Observation:

• A 69-year-old female presented with acute confusion, expressive dysphasia, and focal neurological deficits.
• Neuroimaging revealed multiple peripherally enhancing cavitary brain lesions.
• Tissue analysis confirmed Balamuthia mandrillaris infection consistent with granulomatous amoebic encephalitis.

Findings:

• Immunohistochemistry and PCR confirmed Balamuthia mandrillaris infection.
• The patient received a multi-drug regimen including pentamidine, sulfadiazine, azithromycin, fluconazole, flucytosine, and miltefosine.
• Despite treatment, the patient experienced an ischemic stroke and succumbed to the infection.

Implications:

• This case underscores the diagnostic challenges and poor prognosis associated with Balamuthia mandrillaris encephalitis.
• Early recognition and aggressive multi-agent therapy are crucial, though outcomes remain grim.
• Further research into novel therapeutic strategies is warranted for this devastating infection.