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Fulminant Disseminating Fatal Granulomatous Amebic Encephalitis: The First Case Report in an Immunocompetent Patient

Ju Yeon Lee1, In Kyu Yu2, Seong Min Kim3

  • 1Department of Radiology, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea.

Yonsei Medical Journal
|May 24, 2021
PubMed

Insights

Fatal granulomatous amebic encephalitis caused by Balamuthia mandrillaris is rare in immunocompetent individuals. This case highlights unique MRI findings and clinical course for earlier diagnosis of this CNS infection.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Radiology

Background:

  • Free-living amoeba infections of the central nervous system (CNS) are exceptionally rare but frequently fatal.
  • Amebic meningoencephalitis typically presents with non-specific ring-enhancing lesions on neuroimaging.

Observation:

  • This report details the first documented case of fulminant, disseminated, fatal granulomatous amebic encephalitis (GAE) caused by Balamuthia mandrillaris in an immunocompetent patient in South Korea.
  • The patient's clinical course was unusual, and specific magnetic resonance imaging (MRI) findings were noted.

Findings:

  • MRI revealed a rim-enhancing lesion with characteristic intralesional blooming on susceptibility-weighted imaging (SWI).
  • The lesion also demonstrated low signal intensity on diffusion-weighted images (DWI) and apparent diffusion coefficient (ADC) maps.

Implications:

  • The rarity and non-specific initial imaging findings of GAE pose diagnostic challenges, often leading to initial consideration of tumors or other lesions.
  • Early recognition of characteristic imaging features, such as those observed in this case, is crucial for timely diagnosis and management of Balamuthia mandrillaris encephalitis.
  • This case underscores the importance of considering GAE in the differential diagnosis of CNS infections, especially with specific MRI findings.
Keywords:
Balamuthia mandrillarisEncephalitisamoeba

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