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Background <p>Acanthamoeba spp. typically causes granulomatous amoebic encephalitis in immunocompromised hosts.</p> Objective <p>[<CitationRef CitationID="CR1">1</CitationRef>]&#xa0;To describe an unusual presentation of Acanthamoeba infection manifesting as non-compressive myelopathy in apparently immunocompetent patients.&#xa0;</p> Methods <p>Case series of four patients presenting with progressive spastic quadriparesis at a hospital in Kerala, India. Neuroimaging, cerebrospinal fluid (CSF) analysis, and amoeba-specific PCR were performed. Patients underwent extensive evaluation to exclude common causes of non-compressive myelopathy.</p> Results <p>All four patients were apparently immunocompetent. Neuroimaging revealed spinal cord lesions without encephalitis in two cases. Amoeba-specific PCR of CSF confirmed Acanthamoeba spp. in all patients. Free-Living Amoeba-associated Parainfectious Neuroinflammation Syndrome (FLA-PINS) was diagnosed. Patients showed significant clinical and CSF improvement following <i>anti-acanthamoeba</i> therapy at 2-5 months of follow-up.</p> Conclusions <p>Acanthamoeba infection should be considered as a differential diagnosis for non-compressive myelopathy, particularly in endemic regions. Systematic screening can prevent misdiagnosis of incurable neurodegenerative diseases and enable appropriate treatment.</p>

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Acanthamoeba myelopathy mimicking tropical spastic paraparesis in immunocompetent hosts: a case series

  • 期刊论文

  • 发表日期：

    2026年2月28日

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  • Remya Prakash,
  • Aravind Reghukumar,
  • Rammohan K,
  • Jaichand Johnson,
  • Swapna R. Nath,
  • Saritha Narayanankutty,
  • Deepthi Somarajan,
  • Megha Sayikumar,
  • Athira Vijayan Remadevi,
  • Fida Ali Kalathil,
  • Alby Maria Mathews

摘要

Background

Acanthamoeba spp. typically causes granulomatous amoebic encephalitis in immunocompromised hosts.

Objective

[1] To describe an unusual presentation of Acanthamoeba infection manifesting as non-compressive myelopathy in apparently immunocompetent patients. 

Methods

Case series of four patients presenting with progressive spastic quadriparesis at a hospital in Kerala, India. Neuroimaging, cerebrospinal fluid (CSF) analysis, and amoeba-specific PCR were performed. Patients underwent extensive evaluation to exclude common causes of non-compressive myelopathy.

Results

All four patients were apparently immunocompetent. Neuroimaging revealed spinal cord lesions without encephalitis in two cases. Amoeba-specific PCR of CSF confirmed Acanthamoeba spp. in all patients. Free-Living Amoeba-associated Parainfectious Neuroinflammation Syndrome (FLA-PINS) was diagnosed. Patients showed significant clinical and CSF improvement following anti-acanthamoeba therapy at 2-5 months of follow-up.

Conclusions

Acanthamoeba infection should be considered as a differential diagnosis for non-compressive myelopathy, particularly in endemic regions. Systematic screening can prevent misdiagnosis of incurable neurodegenerative diseases and enable appropriate treatment.