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Granulomatous amoebic encephalitis caused by Acanthamoeba in a patient with AIDS: a challenging diagnosis
Hsien Lee Lau1, Daniela F De Lima Corvino2, Francisco M Guerra2
1Departments of Neurology, Miller School of Medicine University of Miami, Miami, FL, USA.
Introduction:
Acanthamoeba spp. is a ubiquitous free-living amoeba that causes human infections affecting predominantly the cornea and central nervous system. The diagnosis and treatment of Acanthamoeba encephalitis is very challenging.
Case Summary:
A 53-year-old male with HIV/AIDS was admitted for altered mental status and fever. On initial examination, he had left hemianopia with left-sided weakness and numbness. MRI revealed an inflammatory and enhancing parenchymal mass associated with leptomeningeal enhancement in the occipitoparietal lobe containing multiple punctate hemorrhages. He was treated with empiric antibiotics for presumptive toxoplasmosis, brain abscess, fungal infection and tuberculosis with an unremarkable lymphoma work up. Initial brain biopsy studies were unremarkable except for non-specific granulomas and adjacent necrotic tissue. The patient passed away 2.5 months after initial presentation with no diagnosis. Post-mortem testing by the Centers for Disease Control and Prevention (CDC) confirmed the diagnosis of granulomatous amoebic encephalitis (GAE) by visualization with immunohistochemistry staining and PCR. Recovery is rare from GAE likely due to delay in diagnosis.
Conclusions:
This case illustrates the importance of including GAE into the differential diagnosis of brain mass. We advocate early molecular testing of tissue specimen by the CDC to achieve an appropriate diagnosis, and a multidisciplinary approach for the management of this condition.
Insights
Granulomatous amoebic encephalitis (GAE) is a rare but fatal infection. Early diagnosis through molecular testing is crucial for patient survival, as exemplified by this challenging case.
Area of Science:
- Neurology
- Infectious Diseases
- Microbiology
Background:
- Acanthamoeba species are ubiquitous protozoa causing severe human infections, particularly affecting the central nervous system.
- Acanthamoeba encephalitis presents diagnostic and therapeutic challenges, often leading to poor outcomes.
Observation:
- A 53-year-old male with HIV/AIDS presented with altered mental status and neurological deficits.
- Brain MRI revealed a parenchymal mass with leptomeningeal enhancement and punctate hemorrhages.
- Initial treatments for presumed infections were ineffective, and the patient expired without a definitive diagnosis.
Findings:
- Post-mortem examination by the CDC confirmed granulomatous amoebic encephalitis (GAE) via immunohistochemistry and PCR.
- The case highlights the difficulty in diagnosing GAE, contributing to its high mortality rate.
Implications:
- GAE should be considered in the differential diagnosis of brain masses, especially in immunocompromised individuals.
- Early molecular diagnostic testing by specialized centers like the CDC is vital for timely diagnosis and management.
- A multidisciplinary approach is recommended for managing GAE.
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