J Neurocrit Care.  2024 Dec;17(2):88-93. 10.18700/jnc.240032.

Granulomatous amebic encephalitis in a patient treated with chemotherapy: a case report and literature review

• Flores MR
• Montion MG
• Usman AN
• Ngene MA
• Ruxmohan S

• KMID: 2563028
• DOI: http://doi.org/10.18700/jnc.240032

Abstract

Background
Granulomatous amebic encephalitis (GAE) is caused by Acanthamoeba species or Balamuthia mandrillaris, which are microscopic, free-living amoebas found worldwide. People with compromised immune systems are at an increased risk of fatal cerebral infection caused by Acanthamoeba species, whereas B. mandrillaris can affect both immunocompromised and immunocompetent patients. Infections can involve the central nervous system causing GAE.
Case Report
A 71-year-old Caucasian woman, previously diagnosed with chronic lymphocytic leukemia and undergoing chemotherapy, arrived at the emergency department exhibiting seizure-like symptoms. Brain imaging revealed bilateral cerebral masses with central necrosis and hemorrhage, among other findings. The patient underwent a biopsy and was diagnosed with GAE.
Conclusion
Unfortunately, even with the correct diagnosis, GAE leads to rapid deterioration and a higher risk of mortality. This case demonstrates the rapid and severe nature of GAE and emphasizes the need for ongoing studies and better treatment options to improve GAE outcomes.

Keyword

Immunocompromised; Amoeba; Central nervous system infection; Encephalitis; Neurocritical care; Granulomatous amebic encephalitis

Figure

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  Fig. 1. Brain magnetic resonance imaging with T2 fluid-attenuated inversion recovery. (A) A lesion with central necrosis, where the ameba is located, surrounded by vasogenic edema (arrow). (B) Vasogenic edema causing a compression of the left lateral ventricle (arrow). (C) A parenchymal lesion (arrow).

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  Fig. 2. Brain magnetic resonance imaging with T2 fluid-attenuated inversion recovery following the treatment protocol. (A) The necrotizing lesion with an improved surrounding vasogenic edema (arrow). (B, C) Improved vasogenic edema based on the size and mass effect decreased (arrows) when compared to Fig. 1.

Reference

1. Chalmers RM. Acanthamoeba. In: Percival SL, Yates MV, Williams DW, Chalmers RM, Gray NF. Microbiology of waterborne diseases. Elsevier; 2014. p. 263-76.

2. Centers for Disease Control and Prevention (CDC). Acanthamoeba infection: general information [Internet]. 2024; CDC [cited 2024 Dec 1]. Available from: https://www.cdc.gov/acanthamoeba/about/index.html?CDC_AAref_Val=https://www.cdc.gov/parasites/acanthamoeba/gen_info/index.html.

3. Cope JR, Landa J, Nethercut H, Collier SA, Glaser C, Moser M, et al. The epidemiology and clinical features of Balamuthia mandrillaris disease in the United States, 1974-2016. Clin Infect Dis. 2019; 68:1815–22.

4. Pana A, Vijayan V, Anilkumar AC. Amebic meningoencephalitis [Internet]. StatPearls Publishing; 2023 [cited 2024 Dec 1]. Available from: https://pubmed.ncbi.nlm.nih.gov/28613505/.

5. Kot K, Łanocha-Arendarczyk N, Kosik-Bogacka D. Immunopathogenicity of Acanthamoeba spp. in the brain and lungs. Int J Mol Sci. 2021; 22:1261.

6. Tunkel AR, Glaser CA, Bloch KC, Sejvar JJ, Marra CM, Roos KL, et al. The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2008; 47:303–27.

7. Centers for Disease Control and Prevention (CDC). DPDx: free living amebic infections [Internet]. 2024; CDC [cited 2024 Dec 1]. Available from: https://www.cdc.gov/dpdx/freelivingamebic/index.html.

8. Lau HL, De Lima Corvino DF, Guerra FM Jr, Malik AM, Lichtenberger PN, Gultekin SH, et al. Granulomatous amoebic encephalitis caused by Acanthamoeba in a patient with AIDS: a challenging diagnosis. Acta Clin Belg. 2021; 76:127–31.

9. Haston JC, Serra C, Imada E, Martin E, Ali IK, Cope JR. Acanthamoeba infection and nasal rinsing, United States, 1994-2022. Emerg Infect Dis. 2024; 30:783–5.

10. Laurie MT, White CV, Retallack H, Wu W, Moser MS, Sakanari JA, et al. Functional assessment of 2,177 U.S. and international drugs identifies the quinoline nitroxoline as a potent amoebicidal agent against the pathogen Balamuthia mandrillaris. mBio. 2018; 9:e02051–18.

11. Keane NA, Lane LM, Canniff E, Hare D, Doran S, Wallace E, et al. A surviving case of Acanthamoeba granulomatous amebic encephalitis in a hematopoietic stem cell transplant recipient. Am J Case Rep. 2020; 21:e923219.

12. Spottiswoode N, Pet D, Kim A, Gruenberg K, Shah M, Ramachandran A, et al. Successful treatment of Balamuthia mandrillaris granulomatous amebic encephalitis with nitroxoline. Emerg Infect Dis. 2023; 29:197–201.

13. Spottiswoode N, Haston JC, Hanners NW, Gruenberg K, Kim A, DeRisi JL, et al. Challenges and advances in the medical treatment of granulomatous amebic encephalitis. Ther Adv Infect Dis. 2024; 11:20499361241228340.