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Published on: June 8, 2017

Balamuthia mandrillaris presenting as central nervous system vasculitis in a young child

Emily Anne Carsello1,2, Katelyn Liston3,4, Brandon Maust3,5

  • 1Department of Pediatrics, University of Washington, Seattle, Washington, USA emily.carsello@seattlechildrens.org.

BMJ Case Reports
|August 12, 2026
PubMed

Insights

Balamuthia mandrillaris infection, a rare cause of central nervous system vasculitis, was identified in an immunocompetent child. Advanced diagnostics like metagenomic sequencing aided in its early detection.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Pathology

Background:

  • Balamuthia mandrillaris causes rare, severe infections.
  • Central nervous system (CNS) vasculitis is challenging to diagnose.
  • High mortality associated with Balamuthia infections.

Purpose of the Study:

  • To report a unique case of Balamuthia presenting as CNS vasculitis in a child.
  • To highlight the diagnostic challenges and potential of novel methods.
  • To emphasize Balamuthia as a differential diagnosis in vasculitis cases.

Main Methods:

  • Case presentation of an immunocompetent toddler with CNS vasculitis.
  • Initial diagnosis and treatment for Takayasu arteritis.
  • Advanced diagnostics: CSF metagenomic sequencing, brain biopsy pathology, and PCR for Balamuthia mandrillaris.

Main Results:

  • The patient initially improved with immunosuppression for presumed Takayasu arteritis.
  • Rapid neurological decline occurred despite treatment.
  • Metagenomic sequencing and PCR confirmed Balamuthia mandrillaris infection.

Conclusions:

  • Balamuthia mandrillaris can present as mixed-vessel CNS vasculitis.
  • Consideration of Balamuthia is crucial in unexplained vasculitis cases.
  • Metagenomic sequencing and amoeba PCR offer potential for earlier diagnosis.
Keywords:
Infection (neurology)Infectious diseasesPathologyRadiologyVasculitis

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