Journal of Neuroparasitology
Vol. 3 (2012), Article ID N120801, 7 pages [Full-Text PDF]
Cutaneous Acanthamoebiasis with CNS Involvement Post-Transplantation: Implication for Differential Diagnosis of Skin Lesions in Immunocompromised Patients
Andrea D'Auria,1 Jaime Lin,2 P. Jan Geiseler,2
Rebecca Bandea,4 Sharon Roy,5 Rama Sriram,5 Christopher Paddock,6
Sherif Zaki,6 Gene Kim,3 and Govinda S. Visvesvara5
1Department of Pathology and Laboratory Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
2Department of Infectious Disease, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
3Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
4Division of Parasitic Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
5Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
6Division of Viral and Rickettsial Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
Received 9 August 2012; Revised 14 September 2012; Accepted 21 September 2012
We report a 62-year-old male who presented status post lung transplantation with
subcutaneous nodules. One week later, he showed signs of altered mental status; brain
imaging demonstrated mass effect in the cerebellum and meningoencephalitis. In spite of
treatment with a broad range of antimicrobials, he died. A punch biopsy of the skin
lesions showed a superficial and deep mixed inflammatory infiltrate admixed with large
mononuclear cells. A diagnosis of cutaneous amoebiasis was made and the amoebae were
identified as Acanthamoeba spp. based on immunofluorescent stains and PCR assays.
Cutaneous Acanthamoebiasis is a rare infection in immunocompromised patients,
particularly organ recipients. It is important that this entity is included in the
differential diagnosis of immunocompromised patients who have cutaneous infections
that are not responding to antibiotics. An early diagnosis is crucial since cutaneous
Acanthamoebiasis can disseminate to the central nervous system and cause
granulomatous amoebic encephalitis (GAE), which is usually fatal.
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