1601 - A Case of Granulomatous Amebic Encephalitis

Case Diagnosis: 71-year-old female with Balamuthia mandrillaris encephalitis

Case Description: A 71-year-old female presented with a 2-week history of ataxia, dizziness, and confusion. Prior to symptoms, she was living alone. MRI revealed ring-enhancing lesions consistent with tumor. On 07/12, the frontal gyrus mass was resected and she was transferred to inpatient rehabilitation (IPR). One week into IPR, she improved to ambulating 300 feet without a device. Four weeks after initial symptoms, therapy reported new severe ataxia with maximum assist for bed mobility. Biopsy revealed necrosis with atypical glial cells and giant cells. Patient was sent back to acute care for work up, and stabilization. Repeat MRI revealed new rim-enhancing lesions that were anatomically consistent with neurologic decline within the coming days. Six weeks after presentation, Balamuthia mandrillaris, a rare ameba was identified as the etiology. The patient, now lacking brainstem reflexes, was able to transferred to supportive care and passed after the resulted.

Discussions: This infection is rare but serious cause of Non-Traumatic Brain Injury with only 109 cases of Balamuthia mandrillaris reported in the United States between 1974-2016. Though this case is very rare, physiatrists should keep a broad differential when patients show a rapid decline in function.

Conclusions: Balamuthia mandrillaris can lead to rapidly declining neurocognitive status and fatality within months. This case demonstrates the unique space an inpatient physiatrists role is in the health care team. Our observation of this patients rapid decline in function aided in her return to the hospital, discovery of diagnosis, and eventual transition to comfort measures only.