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Case Report: Encephalitis Caused by Balamuthia mandrillaris in a 3-Year-Old Iranian Girl

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  • 1 Pathology Department, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran;
  • 2 Neurosurgery Department, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran;
  • 3 Pediatric Intensive Care Division, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran

ABSTRACT

It is about half a century since free-living amoebae were recognized as pathogenic organisms, but there is still much we should learn about these rare fatal human infectious agents. A recently introduced causative agent of granulomatous amoebic encephalitis, Balamuthia mandrillaris, has been reported in a limited number of countries around the world. A 3-year-old girl was referred to our tertiary hospital because of inability to establish a proper diagnosis. She had been experiencing neurologic complaints including ataxia, altered level of consciousness, dizziness, seizure, and left-sided hemiparesis. The patient's history, physical examination results, and laboratory investigations had led to a wide differential diagnosis. Computed tomography (CT) scan and magnetic resonance imaging analyses revealed multiple mass lesions. As a result, the patient underwent an intraoperative frozen section biopsy of the brain lesion. The frozen section study showed numerous cells with amoeba-like appearances in the background of mixed inflammatory cells. Medications for free-living amoebic meningoencephalitis were administered. PCR assay demonstrated B. mandrillaris as the pathogenic amoeba. Unfortunately, the patient died 14 days after her admission. To our knowledge, this is the first report of B. mandrillaris meningoencephalitis in the Middle East and the first time we have captured the organism during a frozen-section study.

Author Notes

Address correspondence to Moeinadin Safavi or Vahid Mehrtash, Pathology Department, Children’s Medical Center, No. 62, Dr Gharib St., Tehran 1419733151, Iran. E-mails: moein.safavi@gmail.com or vahid.mehrtash68@gmail.com

Authors’ addresses: Moeinadin Safavi, Vahid Mehrtash, Mohammad Taghi Haghi Ashtiani, Maryam Sotoudeh Anvari, Nooshin Zaresharifi, and Bita Jafarzadeh, Pathology Department, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran, E-mails: moein.safavi@gmail.com, vahid.mehrtash68@gmail.com, ashtiani20@yahoo.com, maryamsotoudeh2006@gmail.com, nooshin_zaresharifi@yahoo.com, and bta_jafa@yahoo.com. Zohreh Habibi and Milad shafizadeh, Neurosurgery Department, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran, E-mails: zohreh_h56@yahoo.com and milad_shafizadeh@yahoo.com. Masoud Mohammadpour, Pediatric Intensive Care Division, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran, E-mail: mmpour@tums.ac.ir.

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