Case of the Month

Additional history in this case: Well-controlled DM I and celiac disease; swam in freshwater pond 9 months prior to admission; acute hemorrhagic leukoencephalitis was initially suspected given appearance of brain lesions and history of autoimmune disease, prompting onset of steroids; antibiotics were started after progression on MRI and a brain biopsy, but patient died 1 day later

Patients can present with a wide variety of focal neurologic deficits, altered mental status, headaches, and fever.

Exposure status is also variable, and there is uncertainty as to whether B. mandrillaris can be waterborne.

Variability in clinical findings and lack of definitive exposure history mean diagnosis is often delayed.

Multiple focal lesions demonstrating  variable degrees of peripheral enhancement, restricted diffusion, and surrounding vasogenic edema. 

Signs of internal hemorrhage are often reported.

 

Demyelinating disease, neoplasm (especially metastatic)

Combination of antimicrobials including miltefosine, fluconazole, and albendazole

Multiple hemorrhagic cerebral lesions should prompt discussion of amebic infection and possible brain biopsy in the appropriate clinical setting.