Cutaneous Acanthamoebiasis with CNS Involvement Post- Transplantation: Implication for Differential Diagnosis of Skin Lesions in Immunocompromised Patients

Abstract

We report a 62-year-old male who presented status post lung transplantation with subcutaneous nodules. One week later, he showed signs of altered mental status; brain imaging demonstrated mass effect in the cerebellum and meningoencephalitis. In spite of treatment with a broad range of antimicrobials, he died. A punch biopsy of the skin lesions showed a superficial and deep mixed inflammatory infiltrate admixed with large mononuclear cells. A diagnosis of cutaneous amoebiasis was made and the amoebae were identified as Acanthamoeba spp. based on immunofluorescent stains and PCR assays. Cutaneous Acanthamoebiasis is a rare infection in immunocompro- mised patients, particularly organ recipients. It is important that this entity is included in the differential diagnosis of immunocompromised patients who have cutaneous infections that are not responding to antibiotics. An early diagnosis is crucial since cutaneous Acanthamoebiasis can disseminate to the central nervous system and cause granulomatous amoebic encephalitis (GAE), which is usually fatal.