Facial Balamuthia mandrillaris Infection

This case report describes a rare cutaneous facial infection caused by Balamuthia mandrillaris. A 5-year-old boy presented with a red plaque on his left cheek lasting 14 months that had been previously misdiagnosed as a fungal infection without response to treatment. Routine fungal microscopy, histopathology, and molecular testing failed to identify the pathogen. Ultimately, next-generation sequencing of the skin lesion detected sequences of B. mandrillaris, which was subsequently confirmed by quantitative polymerase chain reaction testing. Examination of head magnetic resonance imaging confirmed no central nervous system involvement. The patient was treated with a combination regimen including lincomycin, sulfamethoxazole, and albendazole. After 3 months of therapy, the skin lesions subsided significantly, resulting in a favorable prognosis without the development of fatal granulomatous amebic encephalitis.