title: Balamuthia mandrillaris meningoencephalitis in an immunocompetent patient: an unusual clinical course and a favorable outcome.
abstract: Balamuthia mandrillaris meningoencephalitis is a rare but often fatal infection; only 2 survivors have been reported to date worldwide. We report the case of an apparently immunocompetent patient (72-year-old woman) who developed several episodes of seizures without prior history of respiratory or skin infections. Magnetic resonance imaging with contrast revealed 2 ring-enhancing lesions, one in the right precentral region and the other in the left posterotemporal region. Open biopsy revealed Balamuthia encephalitis. The patient was treated with combination antibiotics (pentamidine, 300 mg intravenously once a day; sulfadiazine, 1.5 g 4 times a day; fluconazole, 400 mg once a day; and clarithromycin, 500 mg 3 times a day) and was discharged home. There have been no significant neurological sequelae at this writing (6 months after biopsy). We present this case with unusual clinical course to raise awareness of this infectious disease, which may have a more favorable outcome if diagnosed and treated in its early states.
authors.affiliation: Department of Pathology, State University of New York-Upstate Medical School, Syracuse, NY 13210, USA.
authors.forename: Sungmi
authors.initials: S
authors.lastname: Jung
authors.forename: Robert L
authors.initials: RL
authors.lastname: Schelper
authors.forename: Govinda S
authors.initials: GS
authors.lastname: Visvesvara
authors.forename: Howard T
authors.initials: HT
authors.lastname: Chang
mesh_terms: D000368:Aged; D000818:Animals; D001932:Brain Neoplasms / Q000175:diagnosis / Q000556:secondary; D020808:Central Nervous System Protozoal Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000469:parasitology*; D017291:Clarithromycin / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D020938:Epilepsy, Partial, Motor / Q000209:etiology; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D007121:Immunocompetence; D016840:Lobosea / Q000302:isolation & purification*; D008279:Magnetic Resonance Imaging; D008590:Meningoencephalitis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000469:parasitology*; D009518:New York; D009894:Opportunistic Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000469:parasitology*; D010419:Pentamidine / Q000627:therapeutic use; D012987:Soil / Q000469:parasitology; D013411:Sulfadiazine / Q000627:therapeutic use; D013781:Texas
chemical_list: D012987:Soil; D013411:Sulfadiazine; D010419:Pentamidine; D015725:Fluconazole; D017291:Clarithromycin