Cutaneous Acanthamoeba Infection Presenting with Granulomatous Vasculitis

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Meredith Park
Paul Googe
Vimal K Derebail
Manish K Saha
Eduard Matkovic
Jennifer Cope
Ibne Karim
Carolyn Ziemer
Sam Wu


Acanthamoeba, amoeba, granulomatous vasculitis


Cutaneous acanthamoebiasis is a rare diagnosis that carries a mortality rate of over 70%. This disease predominantly affects immunocompromised individuals, though infections have been reported in immunocompetent individuals. We report a fatal case of cutaneous Acanthamoeba infection in a patient with granulomatous vasculitis on biopsy, initially thought to be antineutrophil cytoplasmic antibody (ANCA)-negative vasculitis. The patient primarily presented with ulcerating nasal lesions, which subsequently developed into widespread cutaneous lesions. Diagnosis was made months after presentation when amebae were identified during histopathological examination of biopsies obtained repeatedly after the patient failed to improve on standard therapies for ANCA-negative vasculitis. Treatment was unsuccessful, and the patient died due to complications of widespread Acanthamoeba infection. Cutaneous acanthamoebiasis should be considered in the differential diagnosis of granulomatous vasculitis that fails to improve on standard therapies. Early detection and treatment may improve outcomes and reduce mortality in this highly fatal infection.


1. Murakawa GJ, Mccalmont T, Altman J, Telang GH, Kantor GR, Berger TG. Acanthamebiasis With. Published online 2015:2-7.

2. Paltiel M, Powell E, Lynch J, Baranowski B, Martins C. Disseminated cutaneous acanthamebiasis: A case report and review of the literature. Cutis. 2004;73(4):241-248.

3. Aichelburg AC, Walochnik J, Assadian O, et al. Successful Treatment of Disseminated Acanthamoeba sp. Infection with Miltefosine. Emerg Infect Dis • •. 2008;14(11). doi:10.3201/eid1411.070854

4. Steinberg JP, Galindo RL, Kraus ES, Ghanem KG. Disseminated acanthamebiasis in a renal transplant recipient with osteomyelitis and cutaneous lesions: case report and literature review. Clin Infect Dis. 2002;35(5):43-49. doi:10.1086/341973

5. Wiley CA, Safrin RE, Davis CE, et al. Acanthamoeba Meningoencephalitis in a Patient with AIDS. Source J Infect Dis. 1987;155(1):130-133. Accessed May 15, 2022.

6. Schuster FL, Guglielmo BJ, Visvesvara GS. In-vitro activity of miltefosine and voriconazole on clinical isolates of free-living amebas: Balamuthia mandrillaris, Acanthamoeba spp., and Naegleria fowleri. J Eukaryot Microbiol. 2006;53(2):121-126. doi:10.1111/J.1550-7408.2005.00082.X

7. Pagnoux C, Bienvenu B, Guillevin L. The spectrum of granulomatous vasculitides. Futur Rheumatol. 2006;(6):729-750. doi:10.2217/17460816.1.6.729

8. Morrison AO, Morris R, Shannon A, Lauer SR, Guarner J, Kraft CS. Disseminated acanthamoeba infection presenting with cutaneous lesions in an immunocompromised patient: A case report, review of histomorphologic findings, and potential diagnostic pitfalls. Am J Clin Pathol. 2016;145(2):266-270. doi:10.1093/AJCP/AQV081

9. Afshar K, Boydking A, Ganesh S, Herrington C, Michael McFadden P. Rapidly fatal disseminated acanthamoebiasis in a single lung transplant recipient. Ann Transplant. 2013;18(1):108-111. doi:10.12659/AOT.883846

10. Qvarnstrom Y, Visvesvara GS, Sriram R, Da Silva AJ. Multiplex real-time PCR assay for simultaneous detection of Acanthamoeba spp., Balamuthia mandrillaris, and Naegleria fowleri. J Clin Microbiol. 2006;44(10):3589-3595. doi:10.1128/JCM.00875-06

11. Galarza C, Ramos W, Gutierrez EL, et al. Cutaneous acanthamebiasis infection in immunocompetent and immunocompromised patients. Int J Dermatol. 2009;48(12):1324-1329. doi:10.1111/J.1365-4632.2008.03786.X

12. Berbudi A, Rahmadika N, Tjahjadi AI, Ruslami R. SCIENCE BENTHAM. Type 2 Diabetes and its Impact on the Immune System. Curr Diabetes Rev. 2020;16:442-449. doi:10.2174/1573399815666191024085838