An Acute Case of Granulomatous Amoebic Encephalitis-Balamuthia mandrillaris Infection

A 74-year-old woman who exhibited drowsiness was referred to our hospital. Enhanced head magnetic resonance imaging (MRI) revealed multiple ring-enhancing lesions and lesions showing partial mild hemorrhaging. The patient gradually progressed to a comatose condition with notable brain deterioration...

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Bibliographic Details
Published in:Internal Medicine 2018/05/01, Vol.57(9), pp.1313-1316
Main Authors: Takei, Kentarou, Toyoshima, Masaya, Nakamura, Masashi, Sato, Mineshige, Shimizu, Hiroshi, Inoue, Chihiro, Shimizu, Yoshio, Yagita, Kenji
Format: Article
Language:English
Subjects:
Aged
Amebiasis - diagnostic imaging
Amebiasis - pathology
Amoeba
Animals
Autopsies
Autopsy
Balamuthia mandrillaris
Balamuthia mandrillaris - isolation & purification
Brain
Brain - diagnostic imaging
Brain - parasitology
Brain - pathology
Case Report
Central Nervous System Protozoal Infections - pathology
CNS infection
Coma
Drowsiness
Encephalitis
Encephalitis - diagnostic imaging
Encephalitis - pathology
Fatal Outcome
Fatigue
Female
Granuloma - pathology
granulomatous amoebic encephalitis
Histopathology
Humans
Infections
Internal medicine
Japan
Lesions
Magnetic resonance imaging
Neuroimaging
NMR
Nuclear magnetic resonance
Trophozoites
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Summary:A 74-year-old woman who exhibited drowsiness was referred to our hospital. Enhanced head magnetic resonance imaging (MRI) revealed multiple ring-enhancing lesions and lesions showing partial mild hemorrhaging. The patient gradually progressed to a comatose condition with notable brain deterioration of unknown cause on follow-up MRI. On day nine, the patient inexplicably died, although brain herniation was suspected. Autopsy and histopathology revealed numerous amoebic trophozoites in the perivascular spaces and within the necrotic tissue. Brain immunostaining tested positive for Balamuthia mandrillaris. Infection due to free-living amoeba is rare in Japan; however, it may increase in the near future due to unknown reasons.
ISSN:0918-2918
1349-7235
DOI:10.2169/internalmedicine.0011-17