Challenges in Diagnosing and Treating Granulomatous Amebic Encephalitis: A Case Report of Fatal Acanthamoeba spp. Encephalitis in an Immunocompetent Patient

Abstract

Granulomatous amebic encephalitis (GAE) is a rare but fatal infection of the central nervous system with a high mortality rate, due to free-living amoebae that are pathogenic to humans and ubiquitous in the environment. In this paper, we report the case of an immunocompetent adult female with no relevant medical history, who presented with acute symptoms resembling a stroke, including altered mental status, slurred speech, brutal proportional right hemiplegia, facial droop and focal to bilateral tonic-clonic seizures, all concomitant with high fever. Subsequent magnetic resonance imaging of the brain revealed diffuse multiple nodular lesions both above and below the tentorium. The initial cerebrospinal fluid (CSF) profile was of no great significance. However, microscopic examination of CSF was able to identify the presence of amoeboid microorganisms and cyst formation, suggestive of a telluric amoeba’s infection. The patient was then treated with a combination of fluconazole and trimethoprim-sulfamethoxazole, but her neurological state continued to decline until she passed away from GAE. In our case report, we highlight the difficulties clinicians encountered in managing this disease, as the clinical and radiological presentation are nonspecific, in addition to the lack of clear therapeutic guidelines after diagnosis. Our findings point up the urgent need for more precise diagnostic criteria and comprehensive treatment protocols to improve patient outcomes.