Bacterial Brain Abscess in a Patient with Granulomatous Amebic Encephalitis. A Misdiagnosis or Free-Living Amoeba Acting as Trojan Horse?

Abstract

Amebic encephalitis is a rare and devastating disease. Mortality rate is almost 90% of cases. Here is described a very rare case of bacterial brain abscess in a patient with recent diagnosis of granulomatous amebic encephalitis. Case Description: A 29 - year - old woman presented with headache, right hemiparesis and tonic - clonic seizure. Patient was diagnosed with granulomatous amebic encephalitis due to Acanthamoeba spp.; although, there was no improvement of symptoms in spite of stablished treatment. Three months after initial diagnosis, a brain MRI showed a ring - enhancing lesion in the left frontal lobe compatible with brain abscess. Patient was scheduled for surgical evacuation and brain abscess was confirmed intraoperatively. However, Gram staining of the purulent content showed gram - positive cocci. Patient improved headache and focal deficit after surgery. Conclusion: It is the first reported case of a patient with central nervous system infection secondary to Acanthamoeba spp. who presented a bacterial brain abscess in a short time.