Centrofacial Balamuthiasis: case report of a rare cutaneous amebic infection

Abstract

Free‐living amebae are ubiquitous in our environment, but rarely cause cutaneous infection. Balamuthia mandrillaris has a predilection for infecting skin of the central face. Infection may be restricted to the skin or associated with life‐threatening central nervous system (CNS) involvement. We report a case of a 91‐year‐old woman, who presented with a non‐healing red plaque over her right cheek. Several punch biopsies exhibited non‐specific granulomatous inflammation without demonstrable fungi or mycobacteria in histochemical stains. She was treated empirically for granulomatous rosacea, but the lesion continued to progress. A larger incisional biopsy was performed in which amebae were observed in hematoxylin‐eosin stained sections. These were retrospectively apparent in the prior punch biopsy specimens. Immunohistochemistry and polymerase chain reaction studies identified the organisms as Balamuthia mandrillaris. Cutaneous infection by B. mandrillaris is a rare condition that is sometimes complicated by life‐threatening CNS involvement and which often evades timely diagnosis due to its rarity and nonspecific clinical manifestations. Moreover, these amebae are easily overlooked in histopathologic sections because of their small number and their resemblance to histiocytes. Dermatopathologists should be familiar with the histopathologic appearance of these organisms and include balamuthiasis and other amebic infections in the differential diagnosis of granulomatous dermatitis.

Cutaneous Balamuthia mandrillaris infection as a precursor to Balamuthia amoebic encephalitis (BAE) in a healthy 84-year-old Californian

“…It was in Germany, far removed from the epicenters of disease located in Lima, Peru and the U.S. states California and Texas, [3] that Nasse first described cutaneous amoebiasis in 1892. Except for skin involvement by the intestinal parasitic amoeba Entamoeba histolytica [5], cutaneous infection by free-living amoebae, i.e.…”

“…Although amoebic infection is more common in the immunocompromised population, (i.e., patients undergoing immunosuppressive therapy for solid organ transplantation, those with autoimmune deficiency syndrome (AIDS), immunocompetent individuals, the subject of the present report included, can also be affected [3]. We present an 84-year-old man from California who contracted cutaneous balamuthiasis of the left upper extremity.…”

Functional Assessment of 2,177 U.S. and International Drugs Identifies the Quinoline Nitroxoline as a Potent Amoebicidal Agent against the Pathogen Balamuthia mandrillaris

“…These symptoms are nonspecific and overlap symptoms caused by more common brain infections such as bacterial and viral meningitis as well as noninfectious neuroinflammatory syndromes. Cutaneous presentation is less common and can produce symptoms ranging from painless swelling to ulceration and formation of large lesions ( 4 – 6 ). Infections involving other organs ranging from the lungs to the eye have also been documented ( 7 , 8 ).…”

Fatal Balamuthia mandrillaris brain infection associated with improper nasal lavage

“…While Balamuthia and Naegleria share some similarities, Balamuthia is more difficult to detect. This is due to its resemblance to histiocytes under the microscope (Chang et al, 2016) and unique culture requirements: unlike Naegleria, Balamuthia cannot be grown on agar because it only feeds on mammalian cells and other amoebas (Dunneback, 2007). Furthermore, healthy individuals can be seropositive for Balamuthia antibodies due to the amoeba's pervasive presence in the environment, while those with GAE show low titers (Siddiqui and Khan, 2008).…”

“…Balamuthia mandrillaris is a free-living amoeba that is found in the soil and fresh water and is associated with granulomatous amoebic encephalitis (GAE) (Chang et al, 2016). It was discovered in 1986 in an autopsy specimen from the brain of a mandrill monkey at San Diego Zoo (Visvesvara et al, 1990).…”