Steinberg Jordan P, Galindo Rene L, Kraus Edward S, Ghanem Khalil G
Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD 21209, USA.
Clin Infect Dis. 2002 Sep 1;35(5):e43-9. doi: 10.1086/341973. Epub 2002 Aug 2.
Disseminated acanthamebiasis is a rare disease that occurs predominantly in patients with human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome but also in immunosuppressed transplant recipients. Few reports have focused on non-HIV-infected patients, in whom the disease is more likely to go unsuspected and undiagnosed before death. We describe a renal transplant recipient with Acanthamoeba infection and review the literature. The patient presented with osteomyelitis and widespread cutaneous lesions. No causative organism was identified before death, despite multiple biopsies with detailed histological analysis and culture. Disseminated Acanthamoeba infection was diagnosed after death, when cysts were observed in histological examination of sections of skin from autopsy, and trophozoites were found in retrospectively reviewed skin biopsy and surgical bone specimens. In any immunosuppressed patient, skin and/or bone lesions that fail to show improvement with broad-spectrum antibiotic therapy should raise the suspicion for disseminated acanthamebiasis. Early recognition and treatment may improve clinical outcomes.
播散性棘阿米巴病是一种罕见疾病，主要发生于人类免疫缺陷病毒（HIV）感染或获得性免疫缺陷综合征患者，但也见于免疫抑制的移植受者。很少有报告关注非HIV感染患者，这类患者在死亡前更有可能未被怀疑和诊断出该病。我们描述了一名肾移植受者的棘阿米巴感染情况并复习相关文献。该患者表现为骨髓炎和广泛的皮肤病变。尽管进行了多次活检并进行了详细的组织学分析和培养，但在死亡前未发现病原体。死后诊断为播散性棘阿米巴感染，尸检皮肤切片的组织学检查中观察到囊肿，回顾性复查皮肤活检和手术骨标本时发现滋养体。对于任何免疫抑制患者，经广谱抗生素治疗后皮肤和/或骨病变未见改善，应怀疑播散性棘阿米巴病。早期识别和治疗可能改善临床结局。
