Disseminated Acanthamoeba infection in a heart transplant recipient treated successfully with a miltefosine-containing regimen: Case report and review of the literature

Abstract

Disseminated acanthamoebiasis is a rare, often fatal, infection most commonly affecting immunocompromised patients. We report a case involving sinuses, skin, and bone in a 60-year-old woman 5 months after heart transplantation. She improved with a combination of flucytosine, fluconazole, miltefosine, and decreased immunosuppression. To our knowledge, this is the first case of successfully treated disseminated acanthamoebiasis in a heart transplant recipient and only the second successful use of miltefosine for this infection among solid organ transplant recipients. Acanthamoeba infection should be considered in transplant recipients with evidence of skin, central nervous system, and sinus infections that are unresponsive to antibiotics. Miltefosine may represent an effective component of a multidrug therapeutic regimen for the treatment of this amoebic infection.

Keywords: Acanthamoeba; heart transplant; miltefosine.

Fig. 1

A) MRI of sinuses before debridement showed opacification consistent with observed mass (red arrows). B) MRI of sinuses 6 months after discharge demonstrated clearance of previous opacifications.

Fig. 2

A) Cutaneous lesion of the right forearm photographed 8 days after initial eruption. B) Photograph of the right forearm at 8-month follow up visit demonstrated resolution.

Fig. 3

A) Immunohistochemical stain of skin biopsy showed Acanthamoeba cysts by immunofluorescence (performed at the CDC). B) Biopsy sample from repeat sinus debridement showed cysts consistent with Acanthamoeba spp. 12 days after the patient’s initial surgery.

Fig. 4

a) Radiograph of the right hand revealed a lytic lesion of the third metacarpal. b) MRI of the hand following debridement showed hollow cavity due to bone destruction.