Fatal disseminated Acanthamoeba infection in a liver transplant recipient immunocompromised by combination therapies for graft-versus-host disease

Abstract

Immunosuppressed solid organ transplant recipients are at increased risk for acquisition of opportunistic pathogens, with potentially fatal consequences. With the introduction of novel immunosuppressive agents used to prevent organ rejection and to treat the sequelae of transplantation, severity and rates of infection with unusual opportunistic pathogens may increase. Various monoclonal antibodies are now being used in the treatment of severe, acute graft-versus-host disease (GVHD), including rituximab, daclizumab, and alemtuzumab. These therapies, particularly when used in combination and with other traditional forms of immunosuppression, may have profound effects on the immune system. Acanthamoeba species are ubiquitous, free-living protozoa that rarely cause disseminated disease in the immunocompromised host. We report a fatal case of disseminated Acanthamoeba infection with a dramatic cutaneous presentation in a liver transplant recipient severely immunocompromised by sequential standard and novel therapies used to successfully treat life-threatening acute GVHD. This case illustrates the current major limitation of these therapies, discusses the cutaneous findings in disseminated acanthamoebiasis, and highlights the need to maintain vigilance for the presence of unusual infection in patients receiving similar therapeutic regimens.

Infection in a rat model reactivates attenuated virulence after long-term axenic culture of Acanthamoeba spp

“…During human infection, strains of Acanthamoeba affect several organs in addition to the brain, including the skin, liver, lungs, kidneys, heart, diaphragm, eyes, adrenal glands, pancreas, prostate, lymph nodes and bone marrow (Mazur & Jóźwiak 1993, Khan 2010, Young et al . 2010).…”

Parasitic Infections in Solid Organ Transplantation

“…This disease can be seen in a variety of solid organ transplant recipient types—kidney, liver, lung and others . Acanthamoeba can cause either focal disease (usually keratitis, granulomatous amoebic encephalitis, brain abscess, pulmonary lesions, cutaneous lesions, or sinusitis) or disseminated acanthamebiasis which is often fatal in transplant recipients .…”

Fulminant and fatal encephalitis caused by Acanthamoeba in a kidney transplant recipient: case report and literature review

“…In addition to standard post‐transplant immunosuppressive agents, the patients in this report and in that of Young et al. had recently received additional T‐cell immunosuppressants (anti‐thymocyte globulin and alemtuzumab) and high doses of corticosteroids, all of which further impair macrophage function . Furthermore, both patients had recently received rituximab.…”

“…In order to heighten awareness of this rare but typically fatal infection, and improve the understanding of its clinical manifestations in SOT recipients, we here summarize the clinical features of the 10 published cases of Acanthamoeba encephalitis in this population (Table ) . Nine of the 10 patients were male and the median age at presentation was 41 years (range: 36–63).…”