AUTHOR=Hu Juan , Zhang Yiqi , Yu Yongwei , Yu Huili , Guo Siruo , Shi Ding , He Jianqin , Hu Chi , Yang Jiqi , Fang Xueling , Xiao Yonghong 

TITLE=Encephalomyelitis Caused by Balamuthia mandrillaris in a Woman With Breast Cancer: A Case Report and Review of the Literature

JOURNAL=Frontiers in Immunology

VOLUME=12

YEAR=2022

URL=https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2021.768065

DOI=10.3389/fimmu.2021.768065

ISSN=1664-3224

ABSTRACT=<p><italic>Balamuthia mandrillaris</italic> is one cause of a rare and severe brain infection called granulomatous amoebic encephalitis (GAE), which has a mortality rate of &gt;90%. Diagnosis of <italic>Balamuthia</italic> GAE is difficult because symptoms are non-specific. Here, we report a case of <italic>Balamuthia</italic> amoebic encephalomyelitis (encephalitis and myelitis) in a woman with breast cancer. She sustained trauma near a garbage dump 2 years ago and subsequently developed a skin lesion with a <italic>Mycobacterium abscessus</italic> infection. She experienced dizziness, lethargy, nausea and vomiting, inability to walk, and deterioration of consciousness. Next-generation sequencing of cerebrospinal fluid (CSF) samples revealed <italic>B. mandrillaris</italic>, and MRI of both brain and spinal cord showed abnormal signals. T-cell receptor (TCR) sequencing of the CSF identified the Top1 TCR. A combination of amphotericin B, flucytosine, fluconazole, sulfamethoxazole, trimethoprim, clarithromycin, pentamidine, and miltefosine was administrated, but she deteriorated gradually and died on day 27 post-admission.</p>