ABSTRACT
Disseminated acanthamoebiasis is a rare, often fatal, infection most commonly affecting immunocompromised patients. We report a case involving sinuses, skin, and bone in a 60-year-old woman 5 months after heart transplantation. She improved with a combination of flucytosine, fluconazole, miltefosine, and decreased immunosuppression. To our knowledge, this is the first case of successfully treated disseminated acanthamoebiasis in a heart transplant recipient and only the second successful use of miltefosine for this infection among solid organ transplant recipients. Acanthamoeba infection should be considered in transplant recipients with evidence of skin, central nervous system, and sinus infections that are unresponsive to antibiotics. Miltefosine may represent an effective component of a multidrug therapeutic regimen for the treatment of this amoebic infection.
Subject(s)
Acanthamoeba/isolation & purification , Amebiasis/drug therapy , Amebicides/therapeutic use , Drugs, Investigational/therapeutic use , Immunosuppressive Agents/adverse effects , Phosphorylcholine/analogs & derivatives , Sinusitis/drug therapy , Amebiasis/blood , Amebiasis/diagnosis , Amebiasis/parasitology , Amebicides/administration & dosage , Amebicides/adverse effects , Amphotericin B/therapeutic use , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Antilymphocyte Serum/adverse effects , Antilymphocyte Serum/therapeutic use , Biopsy , Cardiomyopathies/surgery , Drugs, Investigational/administration & dosage , Drugs, Investigational/adverse effects , Endoscopy , Female , Fluconazole/therapeutic use , Flucytosine/therapeutic use , Heart Transplantation/adverse effects , Humans , Immunocompromised Host , Immunosuppressive Agents/therapeutic use , Magnetic Resonance Imaging , Metacarpal Bones/diagnostic imaging , Metacarpal Bones/parasitology , Metacarpal Bones/pathology , Metacarpal Bones/surgery , Metronidazole/therapeutic use , Middle Aged , Phosphorylcholine/administration & dosage , Phosphorylcholine/adverse effects , Phosphorylcholine/therapeutic use , Polymerase Chain Reaction , Radiography , Sinusitis/diagnosis , Sinusitis/parasitology , Skin/parasitology , Skin/pathologyABSTRACT
Rhinosporidiosis is a chronic granulomatous disease caused by Rhinosporidium seeberi. It usually occurs in the mucous membranes of nose, nasopharynx, and eyes, and less commonly in extra nasal sites such as skin, bones, genitalia, and even the internal organs. Rhinosporidiosis occurs in the wrist joint with isolated bony involvement is rare. We report one such case in a 50-year-old man who presented with a non-tender, fixed swelling over his anterolateral aspect of left forearm. Radiography and computed tomography showed a lytic destructive lesion involving the distal radius, ulna, carpals, and base of metacarpals. Biopsy revealed features of rhinosporidiosis. The patient underwent below-elbow amputation.
