SHM Converge Scientific Abstract ePoster Gallery-When a Stroke Is Not a Stroke! A Tragic Case of Acanthamoeba Encephalitis.

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This case describes a 71-year-old man with chronic lymphocytic leukemia (CLL) treated with ibrutinib who presented with fever, aphasia, and right-sided weakness. Initial brain CT showed a left frontal lesion, and he was admitted with concern for stroke and possible meningitis. He was started on broad-spectrum antibiotics, but his confusion and weakness worsened, and repeat imaging showed rapid enlargement of the lesion with vasogenic edema, suggesting an infectious process.<br /><br />Because routine cerebrospinal fluid studies and extensive infectious testing were unrevealing, he was treated empirically with antifungal therapy and later underwent decompressive craniotomy and biopsy. Initial frozen section was nondiagnostic, but final pathology on day 8 revealed amoebic encephalitis caused by Acanthamoeba. He was then started on combination anti-amoebic therapy, including azithromycin, sulfadiazine, flucytosine, fluconazole, and miltefosine. Despite treatment, he continued to decline and was eventually transferred to hospice, where he died.<br /><br />The report emphasizes that Acanthamoeba is a rare but highly fatal cause of granulomatous amebic encephalitis, particularly in immunocompromised patients. It should be considered when patients with systemic symptoms and brain lesions worsen despite broad-spectrum antibacterial and antifungal therapy. This case was notable for its unusually rapid progression and for the absence of granulomas on biopsy, which differs from most typical presentations.

Asset Subtitle

Babar Junaidi

Meta Tag

Author List Babar Junaidi

Category Clinical Vignettes

Concept Acanthamoeba encephalitis

Concept Immunocompromised State

Concept Focal Neurologic Deficit

Concept Cerebrospinal Fluid Studies

Concept Brain biopsy

Distinguished Non-Finalist

Presenter Organization Emory University Hospital

Presenting Author Babar Junaidi

Track Adult

Keywords

Acanthamoeba

granulomatous amebic encephalitis

chronic lymphocytic leukemia

ibrutinib

immunocompromised

brain lesion

aphasia

vasogenic edema

antifungal therapy

miltefosine

Acanthamoeba encephalitis

Immunocompromised State

Focal Neurologic Deficit

Cerebrospinal Fluid Studies

Brain biopsy