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Successful treatment of disseminated Acanthamoeba sp. infection with miltefosine.

Aichelburg AC, Walochnik J, Assadian O, Prosch H, Steuer A, Perneczky G, Visvesvara GS, Aspöck H, Vetter N - Emerging Infect. Dis. (2008)

Bottom Line: We report on an HIV-negative but immunocompromised patient with disseminated acanthamoebiasis, granulomatous, amoebic encephalitis and underlying miliary tuberculosis and tuberculous meningitis.The patient responded favorably to treatment with miltefosine, an alkylphosphocholine.The patient remained well with no signs of infection 2 years after treatment cessation.

View Article: PubMed Central - PubMed

Affiliation: Pulmonological Centre, Otto Wagner Hospital, Vienna, Austria. alexander.aichelburg@wienkav.at

ABSTRACT
We report on an HIV-negative but immunocompromised patient with disseminated acanthamoebiasis, granulomatous, amoebic encephalitis and underlying miliary tuberculosis and tuberculous meningitis. The patient responded favorably to treatment with miltefosine, an alkylphosphocholine. The patient remained well with no signs of infection 2 years after treatment cessation.

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Axial brain magnetic resonance imaging at the level of the cerebellum performed 6 weeks after initial consultation. A) Contrast-enhanced T1 weighted image showing several ring-enhancing lesions in the right cerebellar hemisphere and the right cerebellar peduncle. B) The corresponding fluid attenuation inversion recovery image illustrates the extensive perifocal edema exerting a severe mass effect through compression and displacement of the fourth ventricle with consecutive enlargement of the lateral ventricle.
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Figure 2: Axial brain magnetic resonance imaging at the level of the cerebellum performed 6 weeks after initial consultation. A) Contrast-enhanced T1 weighted image showing several ring-enhancing lesions in the right cerebellar hemisphere and the right cerebellar peduncle. B) The corresponding fluid attenuation inversion recovery image illustrates the extensive perifocal edema exerting a severe mass effect through compression and displacement of the fourth ventricle with consecutive enlargement of the lateral ventricle.

Mentions: Within 12 weeks after initiation of tuberculostatic therapy, complete clinical and radiologic resolution of miliary TB of lungs, liver, spleen, and kidneys could be achieved, and the CD4+ lymphocyte count increased to 421 cells/μL. Nevertheless, the neurologic status of the patient deteriorated, even after liposomal amphotericin B and flucytosine had been added to the regimen. Consecutive cranial CT and cranial MRI scans demonstrated progression of the lesions, with the biggest lesion (1.8 cm in diameter) located in the right cerebellopontine angle and cerebellum (Figure 2, panels A and B).


Successful treatment of disseminated Acanthamoeba sp. infection with miltefosine.

Aichelburg AC, Walochnik J, Assadian O, Prosch H, Steuer A, Perneczky G, Visvesvara GS, Aspöck H, Vetter N - Emerging Infect. Dis. (2008)

Axial brain magnetic resonance imaging at the level of the cerebellum performed 6 weeks after initial consultation. A) Contrast-enhanced T1 weighted image showing several ring-enhancing lesions in the right cerebellar hemisphere and the right cerebellar peduncle. B) The corresponding fluid attenuation inversion recovery image illustrates the extensive perifocal edema exerting a severe mass effect through compression and displacement of the fourth ventricle with consecutive enlargement of the lateral ventricle.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2630722&req=5

Figure 2: Axial brain magnetic resonance imaging at the level of the cerebellum performed 6 weeks after initial consultation. A) Contrast-enhanced T1 weighted image showing several ring-enhancing lesions in the right cerebellar hemisphere and the right cerebellar peduncle. B) The corresponding fluid attenuation inversion recovery image illustrates the extensive perifocal edema exerting a severe mass effect through compression and displacement of the fourth ventricle with consecutive enlargement of the lateral ventricle.
Mentions: Within 12 weeks after initiation of tuberculostatic therapy, complete clinical and radiologic resolution of miliary TB of lungs, liver, spleen, and kidneys could be achieved, and the CD4+ lymphocyte count increased to 421 cells/μL. Nevertheless, the neurologic status of the patient deteriorated, even after liposomal amphotericin B and flucytosine had been added to the regimen. Consecutive cranial CT and cranial MRI scans demonstrated progression of the lesions, with the biggest lesion (1.8 cm in diameter) located in the right cerebellopontine angle and cerebellum (Figure 2, panels A and B).

Bottom Line: We report on an HIV-negative but immunocompromised patient with disseminated acanthamoebiasis, granulomatous, amoebic encephalitis and underlying miliary tuberculosis and tuberculous meningitis.The patient responded favorably to treatment with miltefosine, an alkylphosphocholine.The patient remained well with no signs of infection 2 years after treatment cessation.

View Article: PubMed Central - PubMed

Affiliation: Pulmonological Centre, Otto Wagner Hospital, Vienna, Austria. alexander.aichelburg@wienkav.at

ABSTRACT
We report on an HIV-negative but immunocompromised patient with disseminated acanthamoebiasis, granulomatous, amoebic encephalitis and underlying miliary tuberculosis and tuberculous meningitis. The patient responded favorably to treatment with miltefosine, an alkylphosphocholine. The patient remained well with no signs of infection 2 years after treatment cessation.

Show MeSH
Related in: MedlinePlus