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Acanthamoebic Meningoencephalitis: Lessons in Avoiding a Postmortem Diagnosis
Author(s) -
Pritt Bobbi S.,
Parisi Joseph E.,
Scheithauer Bernd W,
Kingsley Thomas C.,
Jansen Robert D
Publication year - 2007
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.21.5.a403
Subject(s) - acanthamoeba , medicine , pathology , meningoencephalitis , autopsy , grocott's methenamine silver stain , encephalitis , biopsy , brain biopsy , naegleria fowleri , staining , biology , immunology , virus , microbiology and biotechnology
A 38‐year‐old woman, status‐post renal transplant on immunosuppressive therapy, presented with fever, hypotension, and painful erythematous nodules on her chest, abdomen, and back. Skin biopsy revealed panniculitis with fat necrosis, and corresponding cultures showed no growth. Over the next 5 days, she became obtunded and developed a left hemiparesis. MRI showed non‐enhancing bilateral lesions in the cerebral cortex. She deteriorated and died. At autopsy, the 954 gram brain demonstrated flattened gyri and multiple disseminated necrotic foci. Microscopically, numerous cysts and trophozoites were identified within necrotic foci, consistent with Acanthamoeba spp. Review of the skin biopsy revealed similar organisms. Unlike primary amebic meningoencephalitis in healthy children and young adults caused by Naglearia fowlerii, encephalitis due to Acanthamoeba spp. is a subacute, progressive disease of immunocompromised patients. The double‐walled, cysts of Acanthamoeba spp. stain with H&E and Gomori Methenamine Silver, and may be mistaken for a fungus. Knowledge of the epidemiology and microscopic appearance of Acanthamoeba spp. is essential for accurate and timely diagnosis of this serious and potentially treatable infection.