Disseminated Acanthamoebiasis

Abstract

A 60‐year‐old male with a history of pulmonary fibrosis and lung transplant presented to clinic with a three week history of cutaneous eruption on the extremities associated with nausea and fatigue. His medications included prednisone and azathioprine. Exam revealed the patient was afebrile with multiple perforating nodules and subcutaneous nodules in a sporotrichoid pattern over the extremities. Tissue was sent for histopathological evaluation, and culture for bacteria, acid‐fast bacteria, and deep fungal organisms was performed. Histopathology revealed necrotizing panniculitis, but no organisms were found, and tissue cultures were negative. Due to choreoathetoid movements of the right extremities and persistence of cutaneous nodules, the patient was hospitalized and an extensive search for infectious etiology of his condition undertaken. Empiric antibacterial and antifungal therapy was given, but he progressed to multiorgan failure and expired. Autopsy revealed rare amoebic trophozoite forms in the skin in addition to cysts in the lung and brain. Cause of death was determined to be disseminated Acanthamoebiasis. Review of initial skin biopsy showed rare trophozoites. Differing from Entamoeba, Acanthamoeba is a rare but important emerging pathogen. Histopathological diagnosis of Acanthamoeba rests on high index of suspicion in cases of suspected infectious etiology.