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Background <p>Balamuthia amoebic encephalitis (BAE) is a rare and highly fatal central nervous system infection, with a mortality rate exceeding 95%. It often presents with non-specific clinical and neuroimaging features, mimicking intracranial space-occupying lesions, which leads to frequent misdiagnosis. While more common in immunocompromised hosts, it can also occur in immunocompetent individuals.</p> Case Presentation <p>A previously healthy adult male without immunodeficiency presented with headache and limb weakness. Neuroimaging findings initially suggested a glioma. Metagenomic next-generation sequencing (mNGS) of cerebrospinal fluid ultimately confirmed <i>Balamuthia mandrillaris</i> infection. Due to delayed diagnosis, no specific treatment was administered, and the patient died 17&#xa0;days after symptom onset.</p> Conclusion <p>This case underscores that BAE should be considered even in immunocompetent patients presenting with tumor-like neurological symptoms. mNGS serves as a valuable tool for early and accurate diagnosis, which is critical for improving outcomes. Increased clinical awareness is essential to reduce misdiagnosis and enable timely intervention.</p>

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A Case Report of Balamuthia mandrillaris Amoebic Encephalitis with Only Intracranial Symptoms in a Non-Immunocompromised Patient and Literature Review

  • 期刊论文

  • 发表日期：

    2025年11月7日

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  • Yinuo Liu,
  • Ru Liu,
  • Xinyu Cui,
  • Zhihua Si

摘要

Background

Balamuthia amoebic encephalitis (BAE) is a rare and highly fatal central nervous system infection, with a mortality rate exceeding 95%. It often presents with non-specific clinical and neuroimaging features, mimicking intracranial space-occupying lesions, which leads to frequent misdiagnosis. While more common in immunocompromised hosts, it can also occur in immunocompetent individuals.

Case Presentation

A previously healthy adult male without immunodeficiency presented with headache and limb weakness. Neuroimaging findings initially suggested a glioma. Metagenomic next-generation sequencing (mNGS) of cerebrospinal fluid ultimately confirmed Balamuthia mandrillaris infection. Due to delayed diagnosis, no specific treatment was administered, and the patient died 17 days after symptom onset.

Conclusion

This case underscores that BAE should be considered even in immunocompetent patients presenting with tumor-like neurological symptoms. mNGS serves as a valuable tool for early and accurate diagnosis, which is critical for improving outcomes. Increased clinical awareness is essential to reduce misdiagnosis and enable timely intervention.