Acute granulomatous acanthamoeba encephalitis in an immunocompetent patient.
BACKGROUND
Acanthamoeba sp. are known to cause fatal granulomatous Acanthamoeba encephalitis (GAE) in immunocompromised patients.


METHODS
The case of a 17 year old immunocompetent patient with acute purulent meningoencephalitis is reported.


RESULTS
After substantial improvement of cerebrospinal fluid under conventional antimicrobial treatment the patient was suffering several relapses. The causative agent was identified as Acanthamoeba lenticulata T5 which entered the CNS through a bone dehiscence of ethmoidal cells. Due to severe vasospasm the patient developed multiple strokes, which led to marked neurologic sequels.


CONCLUSIONS
This case report demonstrates successful treatment of usually lethal GAE in an immunocompetent patient with high dose meropenem, linezolid, moxifloxacin and fluconazole followed by a partially adapted antimicrobial combination therapy.
Lackner
Peter
P
Department of Neurology, Innsbruck Medical University, 6020 Innsbruck, Anichstrasse 35, Austria, Europe. peter.lackner@i-med.ac.at
Beer
Ronny
R
Broessner
Gregor
G
Helbok
Raimund
R
Pfausler
Bettina
B
Brenneis
Christian
C
Auer
Herbert
H
Walochnik
Julia
J
Schmutzhard
Erich
E
D000048:Acanthamoeba; D000208:Acute Disease; D000293:Adolescent; D000562:Amebiasis / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy; D001925:Brain Damage, Chronic / Q000175:diagnosis; D020808:Central Nervous System Protozoal Infections / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy; D002555:Cerebrospinal Fluid / Q000469:parasitology; D003422:Critical Care; D005500:Follow-Up Studies; D006099:Granuloma / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy; D006801:Humans; D007121:Immunocompetence / Q000276:immunology; D008297:Male; D014057:Tomography, X-Ray Computed