Takei Kentarou, Toyoshima Masaya, Nakamura Masashi, Sato Mineshige, Shimizu Hiroshi, Inoue Chihiro, Shimizu Yoshio, Yagita Kenji
Department of Neurology, Osaki Citizen Hospital, Japan.
Department of Pathology, Tohoku University School of Medicine, Japan.
Intern Med. 2018 May 1;57(9):1313-1316. doi: 10.2169/internalmedicine.0011-17. Epub 2018 Jan 11.
A 74-year-old woman who exhibited drowsiness was referred to our hospital. Enhanced head magnetic resonance imaging (MRI) revealed multiple ring-enhancing lesions and lesions showing partial mild hemorrhaging. The patient gradually progressed to a comatose condition with notable brain deterioration of unknown cause on follow-up MRI. On day nine, the patient inexplicably died, although brain herniation was suspected. Autopsy and histopathology revealed numerous amoebic trophozoites in the perivascular spaces and within the necrotic tissue. Brain immunostaining tested positive for Balamuthia mandrillaris. Infection due to free-living amoeba is rare in Japan; however, it may increase in the near future due to unknown reasons.
一名出现嗜睡症状的74岁女性被转诊至我院。头颅增强磁共振成像（MRI）显示多个环形强化病灶以及部分轻度出血性病灶。在后续的MRI检查中，患者病情逐渐发展为昏迷状态，脑部出现不明原因的显著恶化。在第9天，尽管怀疑有脑疝形成，但患者却莫名死亡。尸检和组织病理学检查发现血管周围间隙和坏死组织内有大量阿米巴滋养体。脑部免疫染色检测显示曼氏巴贝斯虫呈阳性。在日本，自由生活阿米巴感染较为罕见；然而，由于不明原因，其感染率在不久的将来可能会上升。
