2019 FSA Posters

P052: A CASE OF GRANULOMATOUS AMOEBIC ENCEPHALITIS FROM BALAMUTHIA MANDRILLARIS IN A CRITICAL CARE PATIENT
Lisa Gu, MD, Matthew Hernandez, DO, Christopher Robinson, DO, Jesse Kresak, MD; University of Florida

Introduction: Balamuthia mandrillaris is a free-living environmental amoeba naturally found in soil. Very rarely, it can cause a fatal granulomatous amoebic encephalitis (GAE). Transmission occurs via skin contamination or direct inhalation. Pathogenesis is theorized to include hematogenous spread and, possibly, invasion of the olfactory nerve. There have been approximately 200 cases documented in the world. We describe the risk factors, symptomatology, and clinical progression associated with this disease.

Methods: Data was collected through patient care and electronic medical record chart review. Neuropathology was performed by the University of Florida Department of Pathology.

Results: A 51-year-old male presented to the ICU with new-onset seizures. MRI showed multifocal ring-enhancing lesions and obstructive hydrocephalus. The patient was immunocompetent. Medical history was positive for hypertension and cocaine use. Despite treatment with broad-spectrum anti-infective therapy, the patient clinically progressed, requiring intubation and bilateral ventricular drain placement. Initial infectious work-up was negative for fungal, bacterial, and viral pathogens. Repeat imaging confirmed interval increase in the number of lesions, progression of vasogenic edema, and worsening ventriculitis. Eventually, preliminary next-generation PCR of the blood returned positive for B. mandrillaris. Brain biopsy was performed that showed widespread evidence of GAE consistent with B. mandrillaris. Centers for Disease Control (CDC) testing confirmed the results. The patient was started on anti-helminthic therapy according to the CDC-recommended treatment regimen without success and was later transitioned to comfort care.

Discussion/Conclusion: B. mandrillaris is a rare cause of GAE, with little data to suggest definitive risk factors for development of the disease after exposure. Risk factors are difficult to assess given the rarity of the disease, although transmission may be more common in the southern United States and in Latin America. Our case describes an immunocompetent patient with nasopharyngeal contamination from cocaine use. Although most patients present with only neurological findings, like our patient, some also have cutaneous lesions. Very few cases of patients surviving this disease have been documented, almost all of them sharing early detection and treatment.