Granulomatous Amoebic Encephalitis Caused by Balamuthia Mandrillaris in an Immunocompetent Girl

Abstract

Balamuthia mandrillaris is a recently recognized cause of a rare, devastating infection, granulomatous amoebic encephalitis (GAE). Presenting symptoms of GAE are nonspecific and can last for months before becoming clinically significant. Once the infection involves the central nervous system, death often results within days to weeks. A high degree of clinical suspicion is needed to correctly diagnose this infection because definitive diagnostic tests are presently limited, and even then there are only sparse data concerning effective treatment. The importance of early diagnosis is emphasized because delay likely contributes to the extremely high mortality with this infection. This study presents a previously healthy, immunocompetent 2-year-old female patient who succumbed to GAE secondary to B. mandrillaris, with the intention of raising awareness of this devastating infection. Balamuthia amoebic encephalitis is a devastating form of amoebic encephalitis that is increasingly reported in the literature. GAE should be considered for a patient with atypical encephalitis and single or multiple lesions with surrounding edema evident on neurodiagnostic imaging.