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Amoebic Encephalitis Caused by Balamuthia mandrillaris

Journal of Pathology and Translational Medicine 2019년 53권 5호 p.327 ~ 331
 ( Kum Su-Jung ) - Keimyung University School of Medicine Department of Pathology

 ( Lee Hye-Won ) - Keimyung University School of Medicine Department of Pathology
 ( Jung Hye-Ra ) - Keimyung University School of Medicine Department of Pathology
 ( Choe Mi-Sun ) - Keimyung University School of Medicine Department of Pathology
 ( Kim Sang-Pyo ) - Keimyung University School of Medicine Department of Pathology

Abstract


We present the case of a 71-year-old man who was diagnosed with amoebic encephalitis caused by Balamuthia mandrillaris. He had rheumatic arthritis for 30 years and had undergone continuous treatment with immunosuppressants. First, he complained of partial spasm from the left thigh to the left upper limb. Magnetic resonance imaging revealed multifocal enhancing nodules in the cortical and subcortical area of both cerebral hemispheres, which were suggestive of brain metastases. However, the patient developed fever with stuporous mentality and an open biopsy was performed immediately. Microscopically, numerous amoebic trophozoites, measuring 20 to 25 μm in size, with nuclei containing one to four nucleoli and some scattered cysts having a double-layered wall were noted in the background of hemorrhagic necrosis. Based on the microscopic findings, amoebic encephalitis caused by Balamuthia mandrillaris was diagnosed. The patient died on the 10th day after being admitted at the hospital. The diagnosis of amoebic encephalitis in the early stage is difficult for clinicians. Moreover, most cases undergo rapid deterioration, resulting in fatal consequences. In this report, we present the first case of B. mandrillaris amoebic encephalitis with fatal progression in a Korean patient.

키워드

Amoebic encephalitis; Balamuthia mandrillaris; Histopathologic features
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