BACKGROUND: Granulomatous amebic encephalitis is a rare condition. Only less than 200 cases have been reported worldwide, and only three survivors have been reported to date. Two types of free living ameba are known to cause granulomatous amebic encephalitis, namely Acanthamoeba spp. and Balamuthia mandrillaris.OBJECTIVES: We report the first documented case of granulomatous amebic encephalitis in our institution, and probably in the Philippines. Based on review of previous reports internationally, this may be the youngest patient reported to contract the fatal disease.CASE SUMMARY: We present a case of an 8-month old female infant who initially presented with acute blindness. Cranial ultrasonography, computed tomography and magnetic resonance imaging all showed multiple calcified intracranial lesions with progressive malacic changes. In the course of her confinement, the patient rapidly developed seizures, remittent fever and severe neurological deficits. The patient was unresponsive to anti-koch's therapy, Amphotericin B, Ceftazidime, Amikacin and Ciprofloxacin. Unfortunately, the patient expired on the 39th hospital day. At post mortem autopsy of the brain, hematoxylin and eosin stained sections and periodic acid Schiff stain showed diffuse and chronic necrotizing inflammation with numerous amebic trophozoites surrounding the perivascular area. This confirmed the diagnosis of granulomatous amebic encephalitis. Morphology of the organisms was further confirmed by electron microscopy. However, PCR for Balamuthia DNAwas negative.SIGNIFICANCE: This is the first ever documented case of granulomatous amebic encephalitis in our institution, and also probably the first case reported in our country. The differential diagnosis of amebic encephalitis should be considered among patients with CNS infections who are refractory to treatment, even if the patient has no identified risk factors, since this could affect immunocompetent children.
Encephalitis ; Central Nervous System Infections ; Central Nervous System Diseases