Erschienen in:
04.10.2018 | Case Report
Non-granulomatous cerebellar infection by Acanthamoeba spp. in an immunocompetent host
verfasst von:
Sara Modica, Clelia Miracco, Maria Grazia Cusi, Giacinta Tordini, Vitaliano Francesco Muzii, Francesco Iacoangeli, Claudia Nocentini, Ibne Karim M. Ali, Shantanu Roy, Alfonso Cerase, Giacomo Zanelli, Andrea De Luca, Francesca Montagnani
Erschienen in:
Infection
|
Ausgabe 6/2018
Einloggen, um Zugang zu erhalten
Abstract
Acanthamoeba spp. is a free-living amoeba, frequently involved in keratitis by contact lens in immunocompetent hosts. Anecdotal reports associate Acanthamoeba spp. as a cause of severe granulomatous encephalitis in immunocompromised and, less frequently, in immunocompetent subjects. Data regarding clinical and therapeutic management are scanty and no defined therapeutic guidelines are available. We describe an unusual case of non-granulomatous Acanthamoeba cerebellitis in an immunocompetent adult male, with abrupt onset of neurological impairment, subtle hemorrhagic infarction at magnetic resonance imaging, and initial suspicion of cerebellar neoplasm. Histopathological findings of excised cerebellar mass revealed the presence of necrosis and inflammation with structure resembling amoebic trophozoites, but without granulomas. Polymerase chain reaction from cerebellar tissue was positive for Acanthamoeba T4 genotype. Due to gastrointestinal intolerance to miltefosine, the patient was treated with long-term course of fluconazole and trimethoprim/sulphamethoxazole, obtaining complete clinical and neuroradiological resolution.