Balamuthia mandrillaris and Acanthamoeba amebic encephalitis with neurotoxoplasmosis coinfection in a patient with advanced HIV infection

Abstract

We describe a patient with advanced HIV infection and Balamuthia mandrillaris and Acanthamoeba amebic encephalitis with Toxoplasma gondii coinfection. A multidisciplinary effort and state-of-the-art diagnostic techniques were required for diagnosis. Our patient is the first reported case of an HIV-infected person with dual Balamuthia mandrillaris and Acanthamoeba amebic encephalitis with neurotoxoplasmosis coinfection.

Fig 1

MRI T1 and T2 fluid attenuated inversion recovery (FLAIR) images on admission show a ring-enhancing lesion (2.3 by 2.3 by 2.4 cm) in the left parietal/occipital lobe with surrounding vasogenic edema.

Fig 2

(A) Deep sections revealed these structures suggestive of amebae (arrows). H&E stain; magnification, ×200. (B to E) Higher magnification of amebalike trophozoites. (B and C) H&E stain; magnification, ×1,000. (D and E) Giemsa stain; magnification, ×1,000.

Fig 3

(A) Vascular dissemination, showing degenerating amebas (at arrows) within capillaries. (B) Degenerating amebas in reaction with the anti-Balamuthia antibodies. (C) Degenerating amebas in reaction with the anti-Acanthamoeba antibodies.