Objective:

Describe a unique case of a 9 year old with Balamuthia encephalitis including presenting symptoms, hospital course, diagnostics, imaging, CSF studies, Biopsy findings, and treatment. Raise awareness regarding the diagnosis as early detection can potentially impact outcome. 

Background:

Balamuthia mandrillaris is a rare free-living amoeba that can cause granulomatous amebic encephalitis, primarily affecting the CNS. It poses a diagnostic challenge due to its rarity and non-specific clinical presentation. This is a rare case of a 9 year old child with Balamuthia encephalitis.

Design/Methods:

Patient is a 9-year-old previously healthy child who presented with acute onset of right sided weakness, and severe headaches. Initial imaging (MR) positive for large left frontal lesion measuring 3.6 cm suspicious for neoplasm.  Unfortunately, patient continued to deteriorate clinically with agitation, and altered mentation. Repeat MR with evidence of further enlargement of initial lesion along with new scattered enhancing lesions, suggestive of infectious etiology rather than neoplasm. CSF studies: W10,R2760,G55,P90. Patients condition continued to deteriorate with seizures,  further alteration of mentation requiring mechanical ventilation. Initial brain biopsy, only positive for necrotic tissue. Repeat biopsy revealed Balmuthia mandrillaris amoebic forms, confirming the diagnosis of Balamuthia encephalitis. 

Results:

The rarity of this condition led to a delay in diagnosis, underscoring the importance of considering rare pathogens in pediatric neurological cases. Treatment with antimicrobial agents was initiated with guidance of infectious disease specialists, however, patient unfortunately succumbed to the disease due to elevated ICPs. 

Conclusions:

Balamuthia Encephalitis is a challenging diagnosis, and can result in significant morbidity and mortality. This case highlights the importance of considering rare pathogens in the differential diagnosis of neurological conditions, and the need for prompt diagnostic evaluation, including brain biopsy when necessary. Further research is needed to improve our understanding of this rare amoebic infection and its optimal management.