Amoebic Encephalitis Caused by Balamuthia mandrillaris
Amoebic Encephalitis Caused by Balamuthia mandrillaris
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DOI：
10.4132/jptm.2019.05.14
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发表时间：
2019-09-01
影响因子：
2.4
通讯作者：
Kim, Sang Pyo
中科院分区：
文献类型：
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作者：
Kum, Su Jung;Lee, Hye Won;Kim, Sang Pyo
我们报告一位71岁男性病人，他被诊断为由曼陀罗阿米巴引起的阿米巴脑炎。他患有风湿性关节炎30年，并接受了持续的免疫抑制剂治疗。首先，他抱怨从左大腿到左上肢的部分痉挛。磁共振成像显示双侧大脑皮质和皮质下区域有多灶性强化结节，提示有脑转移。然而，患者出现发烧和迟钝的精神，立即进行了开放活检。镜下可见大量阿米巴滋养体，大小为20~25微米，核内含1~4个核仁，散在囊壁呈双层状。根据镜检结果，诊断为曼陀罗巴拉木斯虫引起的阿米巴脑炎。患者在入院后第10天死亡。阿米巴脑炎的早期诊断对临床医生来说比较困难。此外，病例必须迅速恶化，导致致命后果。在这份报告中，我们提出了首例山竹分支杆菌阿米巴脑炎，并在韩国患者的致命进展。
We present the case of a 71-year-old man who was diagnosed with amoebic encephalitis caused by Balamuthia mandrillaris. He had rheumatic arthritis for 30 years and had undergone continuous treatment with immunosuppressants. First, he complained of partial spasm from the left thigh to the left upper limb. Magnetic resonance imaging revealed multifocal enhancing nodules in the cortical and subcortical area of both cerebral hemispheres, which were suggestive of brain metastases. However, the patient developed fever with stuporous mentality and an open biopsy was performed immediately. Microscopically, numerous amoebic trophozoites, measuring 20 to 25 mu m in size, with nuclei containing one to four nucleoli and some scattered cysts having a double-layered wall were noted in the background of hemorrhagic necrosis. Based on the microscopic findings, amoebic encephalitis caused by Balamuthia mandrillaris was diagnosed. The patient died on the 10th day after being admitted at the hospital. The diagnosis of amoebic encephalitis in the early stage is difficult for clinicians. Moreover, must cases undergo rapid deterioration, resulting in fatal consequences. In this report, we present the first case of B. mandrillaris amoebic encephalitis with fatal progression in a Korean patient.