Unusual presentation of primary amoebic meningoencephalitis--a serious diagnostic and therapeutic problem

A fatal case of meningo-encephalitis due to Amoeba naegleria is discussed. It was a problem for diagnosis because of its unusual presentation. The patient, a young pregnant female presented with pyrexia, severe headache, and photophobia. Anti-biotic therapy was started after a provisional diagnosis of acute pyogenic meningitis had been made. There was no response to antibiotic therapy. Facial nerve palsy and abnormal activity in the left centro-temporal region in the EEG was observed and suspicion of an intra-cranial space occupying lesion was entertained. Carotid angiography and ventriculography, however, showed no abnormality. Repeat cerebrospinal fluid examination revealed motile amoebae. The patient, however, died shortly afterwards. This case is documented for its atypical clinical presentation and therapeutic problems.