Acquired immunodeficiency syndrome associated with Acanthamoeba infection and other opportunistic organisms

A 29-year-old Haitian man with acquired immunodeficiency syndrome presented with nasal obstruction and epistaxis. A computed tomogram of the head showed thickened nasal and paranasal sinus mucosa. A biopsy specimen of the turbinate disclosed inflammatory tissue containing amoebic trophozoites. The patient was empirically treated with rifampin and ketoconazole. He died four months after biopsy of other complications of acquired immunodeficiency syndrome. At autopsy, the amoebic infection was found only in the paranasal sinuses, a calf nodule, and in an intradermal abscess in the left leg. Pneumocystitis carinii pneumonia, Mycobacterium avium-cellulare in the liver and retroperitoneal lymph nodes, cytomegalovirus infection of the adrenal glands, and Kaposi's sarcoma in the spleen were additionally present. The organism was cultured and studied by electron microscopy, dark-field microscopy, and immunofluorescence.