Non-granulomatous meningoencephalitis with Balamuthia mandrillaris mimicking a tumor: First confirmed case from Pakistan

Q3 Medicine
Zanibb Javed, Mustafa Mushtaq Hussain, Najia Ghanchi, Ahmed Gilani, S. Enam
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Abstract

Free-living amoebae rarely instigate intracranial infections that may resemble neoplastic conditions on imaging. Naegleria fowleri precipitates an acute, swiftly fatal meningoencephalitis, whereas Acanthamoeba and Balamuthia species typically manifest with a less aggressive onset but carry equally dire consequences. The case describes a 33-year-old woman with subacute encephalitis caused by Balamuthia mandrillaris. She experienced 2 months of back pain, 1 month of headaches, and 2 weeks of vomiting without fever, recent travel, aquatic activities, or animal exposure. Brain magnetic resonance imaging revealed a sizable, heterogeneous enhancing mass in the right temporal and frontal lobes, accompanied by vasogenic edema and midline shift. Histopathology showed marked inflammation and damage to blood vessels with amoebic trophozoites present. The trophozoites displayed specific characteristics, leading to the diagnosis of amoebic meningoencephalitis. Polymerase chain reaction and Sanger sequencing confirmed B. mandrillaris infection while testing for N. fowleri and Acanthamoeba was negative. Despite antibiotic treatment, the patient’s condition deteriorated rapidly, resulting in death within 2 weeks of presentation. This is the first confirmed case of B. mandrillaris central nervous system (CNS) infection from Pakistan. The incidence of this disease is expected to rise due to increasing temperatures due to climate change and the deteriorating quality of the water supply. Balamuthia meningoencephalitis should, therefore be on the differential for non-neoplastic CNS lesions. Furthermore, an atypical histopathologic picture, including the absence of granulomatous inflammation, needs to be recognized.
模仿肿瘤的山魈巴拉姆瘤非肉芽肿性脑膜脑炎:巴基斯坦首例确诊病例
自由生活的阿米巴原虫很少引发颅内感染,在影像学上可能类似于肿瘤性疾病。瑙格勒氏阿米巴原虫会引发急性、迅速致命的脑膜脑炎,而棘阿米巴原虫和巴拉穆氏阿米巴原虫通常起病较轻,但后果同样严重。她经历了 2 个月的背痛、1 个月的头痛和 2 周的呕吐,但没有发烧、近期旅行、水上活动或动物接触。脑磁共振成像显示,右侧颞叶和额叶有一个相当大的异质强化肿块,伴有血管源性水肿和中线移位。组织病理学显示,血管有明显的炎症和损伤,并伴有阿米巴滋养体。滋养体显示出特殊的特征,因此被诊断为阿米巴脑膜脑炎。聚合酶链式反应和桑格测序证实了曼迪拉氏阿米巴原虫感染,而福氏阿米巴原虫和棘阿米巴原虫的检测结果均为阴性。尽管接受了抗生素治疗,但患者的病情迅速恶化,最终在发病后两周内死亡。这是巴基斯坦首例确诊的山魈鲍曼中枢神经系统(CNS)感染病例。由于气候变化导致气温升高,加上水源质量不断恶化,预计这种疾病的发病率还会上升。因此,Balamuthia 脑膜脑炎应与非肿瘤性中枢神经系统病变相鉴别。此外,还需要认识到非典型的组织病理学表现,包括没有肉芽肿性炎症。
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CiteScore
1.30
自引率
0.00%
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623
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