Cutaneous Balamuthia mandrillaris infection as a precursor to Balamuthia amoebic encephalitis (BAE) in a healthy 84-year-old Californian
| Autor: | James Kunkle, Larisa M. Lehmer, Bruce D. Ragsdale, Gabriel E Ulibarri |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
0301 basic medicine
030213 general clinical medicine Pathology medicine.medical_specialty granulomatous dermatitis Autopsy Dermatology Balamuthia Cutaneous tissue Balamuthia mandrillaris balamuthia amoebic encephalitis 03 medical and health sciences 0302 clinical medicine Medicine BAE Amoebic encephalitis biology cutaneous balamuthiasis business.industry GAE General Medicine biology.organism_classification Regimen 030104 developmental biology biology.protein immunocompromise immune senescence Antibody Granulomatous Dermatitis business granulomatous amoebic encephalitis |
| Zdroj: | Lehmer, Larisa M; Ulibarri, Gabriel E; Ragsdale, Bruce D; & Kunkle, James. (2017). Cutaneous Balamuthia mandrillaris infection as a precursor to Balamuthia amoebic encephalitis (BAE) in a healthy 84-year-old Californian. Dermatology Online Journal, 23(7). Retrieved from: http://www.escholarship.org/uc/item/8c8720qm |
| ISSN: | 1087-2108 |
| DOI: | 10.5070/d3237035732 |
| Popis: | Soil and freshwater-dwelling amoebae may opportunistically infect the skin and evoke a granulomatous dermatitis that camouflages their underlying morphology. Amoebic infestations are incredibly rare in the U.S., predominantly occurring in the young, elderly, and immunocompromised. Sadly, because diagnosis is difficult and unsuspected, most cases are diagnosed at autopsy. The following case is of a healthy 84-year-old man with a non-healing nodulo-ulcerative cutaneous lesion on his left forearm that appeared following a gardening injury. Lesional punch biopsies repeatedly showed non-specific granulomatous inflammation with no pathogens evident histologically or by culture. Histopathologic diagnosis was made five months after initial presentation via identification of amoebic trophozoite forms in tissue from a large excisional specimen. Anti-amoebic therapy was initiated immediately. The patient experienced mental status changes three days following lesion excision, with evidence of a cystic mass in the left medial parieto-occipital lobe by CT. Both intraoperative brain biopsies and cutaneous tissue samples tested positive for Balamuthia mandrillaris by indirect immunofluorescent antibody assay performed at the Centers for Disease Control. The patient achieved a full recovery on a triple antibiotic regimen. Clinical suspicion and thorough histopathologic analysis may determine the difference between survival and death for a patient presenting with a treatment-refractory localized granulomatous lesion. |
| Databáze: | OpenAIRE |
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