Treatment of Granulomatous Amoebic Encephalitis with Voriconazole and Miltefosine in an Immunocompetent Soldier

Duncan Webster Saint John Regional Hospital, Saint John, New Brunswick, Canada; Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Montreal Neurological Institute, McGill University Health Centre, Montreal, Quebec, Canada; Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Centers for Disease Control and Prevention, Atlanta, Georgia

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Imram Umar Saint John Regional Hospital, Saint John, New Brunswick, Canada; Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Montreal Neurological Institute, McGill University Health Centre, Montreal, Quebec, Canada; Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Centers for Disease Control and Prevention, Atlanta, Georgia

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George Kolyvas Saint John Regional Hospital, Saint John, New Brunswick, Canada; Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Montreal Neurological Institute, McGill University Health Centre, Montreal, Quebec, Canada; Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Centers for Disease Control and Prevention, Atlanta, Georgia

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Juan Bilbao Saint John Regional Hospital, Saint John, New Brunswick, Canada; Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Montreal Neurological Institute, McGill University Health Centre, Montreal, Quebec, Canada; Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Centers for Disease Control and Prevention, Atlanta, Georgia

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Marie-Christine Guiot Saint John Regional Hospital, Saint John, New Brunswick, Canada; Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Montreal Neurological Institute, McGill University Health Centre, Montreal, Quebec, Canada; Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Centers for Disease Control and Prevention, Atlanta, Georgia

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Kevin Duplisea Saint John Regional Hospital, Saint John, New Brunswick, Canada; Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Montreal Neurological Institute, McGill University Health Centre, Montreal, Quebec, Canada; Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Centers for Disease Control and Prevention, Atlanta, Georgia

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Yvonne Qvarnstrom Saint John Regional Hospital, Saint John, New Brunswick, Canada; Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Montreal Neurological Institute, McGill University Health Centre, Montreal, Quebec, Canada; Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Centers for Disease Control and Prevention, Atlanta, Georgia

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Govinda S. Visvesvara Saint John Regional Hospital, Saint John, New Brunswick, Canada; Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Montreal Neurological Institute, McGill University Health Centre, Montreal, Quebec, Canada; Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Centers for Disease Control and Prevention, Atlanta, Georgia

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A 38-year-old male immunocompetent soldier developed generalized seizures. He underwent surgical debulking and a progressive demyelinating pseudotumor was identified. Serology and molecular testing confirmed a diagnosis of granulomatous amoebic encephalitis caused by Acanthamoeba sp. in this immunocompetent male. The patient was treated with oral voriconazole and miltefosine with Acanthamoeba titers returning to control levels and serial imaging demonstrating resolution of the residual lesion.

Author Notes

*Address correspondence to Duncan Webster, Saint John Regional Hospital, Department of Internal Medicine, 400 University Ave. Saint John, N.B., E2L 4L2, Canada. E-mail: Duncan.Webster@HorizonNB.ca

Authors' addresses: Duncan Webster, Saint John Regional Hospital, Department of Internal Medicine, Saint John, Canada, E-mail: Duncan.Webster@HorizonNB.ca. Imran Umar, Saint John Regional Hospital, Department of Laboratory Medicine, Saint John, Canada, E-mail: Imran.UmarDr@HorizonNB.ca. George Kolyvas, Saint John Regional Hospital, Department of Neurosurgery, Saint John, Canada, E-mail: George.Kolyvas@HorizonNB.ca. Juan Bilbao, Sunnybrook Health Sciences Centre, Department of Anatomical Pathology, Toronto, Canada, E-mail: Juan.Bilbao@sunnybrook.ca. Marie-Christine Guiot, Montreal Neurological Institute, Montreal, Quebec, Canada, E-mail: marie.christine.guiot@mcgill.ca. Kevin Duplisea, Department of Pharmacy, Toronto Western Hospital, Toronto, Canada, E-mail: Kevin.Duplisea@uhn.on.ca. Yvonne Qvarnstrom, Division of Parasitic Diseases, National Centre for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, E-mail: bvp2@cdc.gov. Govinda S. Visvesvara, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, GA, E-mail: gsv1@cdc.gov.

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