Shirabe Teruo, Monobe Yasumasa, Visvesvara Govinda S
Division of Neuropathology, Kawasaki Medical School, Kurashiki, Japan.
Neuropathology. 2002 Sep;22(3):213-7. doi: 10.1046/j.1440-1789.2002.00444.x.
We report here the first case of amebic meningoencephalitis caused by Balamuthia mandrillaris in a 78-year-old Japanese woman with Sjögren's syndrome. Fourteen days before her death, she presented with high fever and lost consciousness and later developed neck stiffness and abducens palsy. Computed tomography scans of the brain demonstrated multiple low-density areas throughout the brain. Neuropathologically, hemorrhagic and necrotic lesions with many amebic trophozoites were scattered in the brain and spinal cord. Granulomatous lesions were only rarely found. The amebas were identified as Balamuthia mandrillaris based on immunofluorescence assay. Clinicopathologically, our case was thought to be an intermediate between primary amebic meningoencephalitis due to Negleria fowleri and granulomatous amebic encephalitis due to Acanthameba species. Essentially, the case was one of an elderly person with suspected immunodeficiency with fulminant necrotic meningoencephalitis and scanty granulomatous lesions of 14 days course.
我们在此报告首例由曼氏巴贝斯虫引起的阿米巴脑膜脑炎病例，患者为一名78岁患有干燥综合征的日本女性。在她去世前14天，出现高热并失去意识，随后发展为颈部僵硬和展神经麻痹。脑部计算机断层扫描显示全脑有多个低密度区域。神经病理学检查发现，脑和脊髓中有许多阿米巴滋养体的出血性和坏死性病变，仅偶尔发现肉芽肿性病变。基于免疫荧光分析，这些阿米巴被鉴定为曼氏巴贝斯虫。临床病理方面，我们的病例被认为是福氏耐格里阿米巴引起的原发性阿米巴脑膜脑炎和棘阿米巴属引起的肉芽肿性阿米巴脑炎之间的一种中间情况。本质上，该病例是一名疑似免疫缺陷的老年人，患有暴发性坏死性脑膜脑炎，病程14天，肉芽肿性病变较少。
