Granulomatous amebic encephalitis in a multivisceral transplant recipient

Abstract

A 40-year-old man with multivisceral allograft developed acutely right-sided numbness 9 months after transplantation. Cranial magnetic resonance imaging (MRI) showed a small left parietal lesion, and cerebrospinal fluid analysis was unremarkable. Stereotactic brain biopsy was non-diagnostic. The patient continued to deteriorate, developed cerebral edema and died at 13 days after the onset of symptoms. Unexpectedly, autopsy demonstrated acanthamebic encephalitis. This case highlights diagnostic difficulties encountered with amebic encephalitis and expands the spectrum of opportunistic central nervous system (CNS) infections in solid and visceral organ transplant recipients.

Solid Organ Transplant and Parasitic Diseases: A Review of the Clinical Cases in the Last Two Decades

“…Acanthamoeba castellanii typically complicates corneal transplantation leading to progressive keratitis, corneal opacities, or perforation [ 97 ]. It has also been reported in kidney [ 98 , 99 , 108 ], liver [ 105 ], lung [ 101 , 107 ], and multivisceral transplantation [ 100 ]. The total number of reported cases of post-SOT Acanthamoeba spp.…”

“…infection amount to 17 cases. Disseminated acanthamoebiasis in transplant recipients is associated with gastroenteritis, sclerosing cholangitis, encephalitis [ 100 , 101 , 107 ], and osteomyelitis [ 99 ]. A fatal outcome has been reported in most disseminated cases.…”

The clinical spectrum of neurologic disorders after intestinal and multivisceral transplantation

“…All three cases of fatal cerebral aspergillosis presented within seven months after transplantation indicating a greater risk of fungal CNS infections early after transplantation with persistent long‐term risk. Two other cases of fatal parasitic CNS infections ( Toxoplasma , Acanthamoeba ) have also been reported in intestinal and MV transplant recipients (13, 14).…”

Fulminant and fatal encephalitis caused by Acanthamoeba in a kidney transplant recipient: case report and literature review

“…In order to heighten awareness of this rare but typically fatal infection, and improve the understanding of its clinical manifestations in SOT recipients, we here summarize the clinical features of the 10 published cases of Acanthamoeba encephalitis in this population (Table ) . Nine of the 10 patients were male and the median age at presentation was 41 years (range: 36–63).…”

“…In all 6 cases, trophozoites and cysts were visualized on hematoxylin and eosin stains of skin or brain tissue, and the diagnosis was confirmed by molecular or serologic testing or by culturing Acanthamoeba on Escherichia coli agar plates or in broth. In 2 cases, the diagnosis was missed on brain biopsy, and in another case it was missed on both skin and brain biopsies and not made until autopsy . In each instance where the diagnosis was missed, granulomas were not seen and trophozoites were either not seen or misidentified as lymphocytes or macrophages.…”