title: Rapidly fatal disseminated acanthamoebiasis in a single lung transplant recipient.
abstract: BACKGROUND
  Lung transplant recipients are at great risk for developing various infectious complications. These infections portend a significant morbidity and mortality throughout their lifetime following transplantation. At times, cutaneous manifestations are the only clues to systemic infection.
  
  
  METHODS
  A 62 year-old man with a history of idiopathic pulmonary fibrosis presented 6 months after receiving bilateral sequential cadaveric lung transplantation for anorexia, early satiety, weight loss, exertional dsypnea, arthralgia, and depression. On exam, two rapidly growing non-painful 1.5-3 centimeter erythematous nodules with purulent draining on the anterior chest wall were noted. On Hospital Day 7, the patent was found to be un-responsive, hypotensive, and febrile. Brain imaging revealed diffuse thick nodular enhancement of leptomeningeal surface and multiple areas of hypodenisty associated with mass effect in the bilateral vermis and cerebellar hemispheres with effacement of the fourth ventricle. CSF PCR analysis showed Acanthamoeba sp. confirmed by the Center for Disease Control. Despite multi-modal therapy, his clinical course deteriorated and resulted in brain death.
  
  
  CONCLUSIONS
  Acanthamoeba infection is extremely rare in thoracic organ recipients. We report the fifth case of progressive disseminated acanthamoebiasis in a lung transplant recipient.
authors.affiliation: University of Southern California, Keck School of Medicine, Division of Pulmonary and Critical Care Medicine, Los Angeles, CA, USA. kafshar@usc.edu
authors.forename: Kamyar
authors.initials: K
authors.lastname: Afshar
authors.forename: Ayana
authors.initials: A
authors.lastname: Boydking
authors.forename: Sivagini
authors.initials: S
authors.lastname: Ganesh
authors.forename: Cynthia
authors.initials: C
authors.lastname: Herrington
authors.forename: P Michael
authors.initials: PM
authors.lastname: McFadden
mesh_terms: D000048:Acanthamoeba; D000562:Amebiasis / Q000175:diagnosis / Q000209:etiology*; D004660:Encephalitis / Q000175:diagnosis / Q000209:etiology; D017809:Fatal Outcome; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000175:diagnosis / Q000209:etiology; D012874:Skin Diseases, Infectious / Q000175:diagnosis / Q000209:etiology