Abstract Details

Title Acanthamoeba Encephalitis Mimicking Recurrent Strokes

Topic Infectious Disease

Presentation(s) Infectious Disease Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 052

Objective NA

Background

Acanthamoeba encephalitis is a central nervous system infection with high mortality. It is increasingly recognized as a cause of infection in immunocompromised patients.

Design/Methods NA

Results Case Report: A 77-year-old male with a history of end-stage renal disease, status post renal transplant in 2019, presented in May 2020 for right hand weakness. Brain MRI showed restricted diffusion involving the left internal capsule extending into the left midbrain and pons, attributed to stroke. One month later, he had declining right-sided strength and loss of vision in the right eye. In early September, he experienced left eye vision loss and became incoherent. He was diagnosed with recurrent strokes at outside centers. He was re-referred to UCLA Medical Center in September 2020. MRI brain showed persistent diffusion restriction as seen in May with an additional area of diffusion restriction in the anterior medulla. MRI of the orbits demonstrated enhancement and edema of the posterior right optic nerve. MRI of the cervical and thoracic spine demonstrated scattered foci of T2 hyperintensity at multiple levels. The extensive CNS involvement, insidious progression, and history of immunosuppression prompted testing for occult infectious etiologies. CSF showed <1 RBC, 1 WBC, protein 44, and glucose 112, with opening pressure of 22 cm H2O. Next generation sequencing (NGS) of CSF found Parachylamidae acanthamoeba above reporting thresholds. As this bacterium typically grows within Acanthamoeba spp., his clinical presentation prompted empiric treatment for Acanthamoeba encephalitis. He was treated with IV fluconazole, flucytosine, miltefosine and sulfadiazine. After one week of treatment, his mental status and neurologic exam improved.

Conclusions Diagnoses of Acanthamoeba encephalitis are typically accomplished by tissue examination. However, this patient did not have biopsy-accessible lesions and was diagnosed using CSF NGS-guided methods. Other cases of Acanthamoeba encephalitis have been reported and have survived after similar regimens of fluconazole, flucytosine, miltefosine and sulfadiazine.

Authors/Disclosures
Katherine Fu, MD (University of California, Los Angeles) PRESENTER	Dr. Fu has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for �鶹��ýӳ��: Neurology Journal . Dr. Fu has received research support from �鶹��ýӳ��. Dr. Fu has received personal compensation in the range of $0-$499 for serving as a Edmond J. Safra Fellowship Reviewer with The Michael J. Fox Foundation.
William P. Flavin, MD, PhD (University of California Los Angeles)	The institution of Dr. Flavin has received research support from National Institute of Neurological Disorders and Stroke. The institution of Dr. Flavin has received research support from Waxman Family Foundation.
	No disclosure on file
Elyse J. Singer, MD (Dept of Neurology, David Geffen School of Medicine@UCLA)	The institution of Dr. Singer has received research support from NIH. Dr. Singer has received personal compensation in the range of $1,000,000+ for serving as a Principal investigator/Study section with NIH.
Jeff M. Bronstein, MD, PhD (UCLA)	Dr. Bronstein has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ultragenyx. The institution of Dr. Bronstein has received research support from NIH. The institution of Dr. Bronstein has received research support from Levine Foundation.
Inna Keselman, MD, PhD (UCLA)	Dr. Keselman has nothing to disclose.

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