Disseminated acanthamoeba infection presenting with cutaneous lesions in an immunocompromised patient: A case report, review of histomorphologic findings, and potential diagnostic pitfalls

Annie O. Morrison, Robert Morris, Amie Shannon, Scott R. Lauer, Jeannette Guarner, Colleen S. Kraft

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Objectives: Free-living amoebas are exceedingly rare causes of cutaneous infections and present unique diagnostic and therapeutic challenges. We describe a case of disseminated acanthamoebiasis with cutaneous manifestations and summarize additional diagnostic, prognostic, and therapeutic highlights. Methods: A 58-year-old man with relapsed chronic lymphocytic leukemia had several weeks of progressive, painful ulcerations on the forehead, arms, abdomen, and thighs. A biopsy was performed for histopathologic evaluation. Results: The biopsy specimen showed inflammatory infiltrate with abscess formation involving the epidermis, dermis, and subcutis. Scattered cells showed nuclei with a prominent central karyosome, dispersed chromatin, and either abundant foamy basophilic cytoplasm or two welldemarcated cytoplasmic walls. Acanthamoeba species was confirmed by polymerase chain reaction from the formalinfixed, paraffin-embedded tissue. Conclusions: Cutaneous lesions from acanthamoebiasis are exceptionally rare but should be included in the differential diagnosis of necrotic cutaneous lesions in immunocompromised patients. Although infrequently encountered, pathologists need to be aware of the morphologic features of freeliving amoebas. Immunohistochemical and molecular studies can confirm the diagnosis. Multiagent treatment regimens, when initiated empirically, have been more successful than single-agent regimens, but infections involving the central nervous system are almost universally fatal.

Original languageEnglish (US)
Pages (from-to)266-270
Number of pages5
JournalAmerican journal of clinical pathology
Volume145
Issue number2
DOIs
StatePublished - Feb 1 2016

Fingerprint

Acanthamoeba
Immunocompromised Host
Amoeba
Skin
Infection
Biopsy
Skin Manifestations
Central Nervous System Infections
Forehead
B-Cell Chronic Lymphocytic Leukemia
Dermis
Thigh
Cell Nucleus
Epidermis
Abdomen
Paraffin
Abscess
Chromatin
Cytoplasm
Arm

Keywords

  • Acanthamoeba
  • Acanthamoebiasis
  • Amoebiasis
  • Amoebic infection
  • Cutaneous amoeba
  • Opportunistic infection

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Disseminated acanthamoeba infection presenting with cutaneous lesions in an immunocompromised patient : A case report, review of histomorphologic findings, and potential diagnostic pitfalls. / Morrison, Annie O.; Morris, Robert; Shannon, Amie; Lauer, Scott R.; Guarner, Jeannette; Kraft, Colleen S.

In: American journal of clinical pathology, Vol. 145, No. 2, 01.02.2016, p. 266-270.

Research output: Contribution to journalArticle

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abstract = "Objectives: Free-living amoebas are exceedingly rare causes of cutaneous infections and present unique diagnostic and therapeutic challenges. We describe a case of disseminated acanthamoebiasis with cutaneous manifestations and summarize additional diagnostic, prognostic, and therapeutic highlights. Methods: A 58-year-old man with relapsed chronic lymphocytic leukemia had several weeks of progressive, painful ulcerations on the forehead, arms, abdomen, and thighs. A biopsy was performed for histopathologic evaluation. Results: The biopsy specimen showed inflammatory infiltrate with abscess formation involving the epidermis, dermis, and subcutis. Scattered cells showed nuclei with a prominent central karyosome, dispersed chromatin, and either abundant foamy basophilic cytoplasm or two welldemarcated cytoplasmic walls. Acanthamoeba species was confirmed by polymerase chain reaction from the formalinfixed, paraffin-embedded tissue. Conclusions: Cutaneous lesions from acanthamoebiasis are exceptionally rare but should be included in the differential diagnosis of necrotic cutaneous lesions in immunocompromised patients. Although infrequently encountered, pathologists need to be aware of the morphologic features of freeliving amoebas. Immunohistochemical and molecular studies can confirm the diagnosis. Multiagent treatment regimens, when initiated empirically, have been more successful than single-agent regimens, but infections involving the central nervous system are almost universally fatal.",
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