PMC6092972_01
Axial T2-FLAIR MRI brain. (a) MRI at initial presentation shows the focal area of increased signal in the right frontal cortex (yellow arrow) along with areas of abnormal white matter signal abnormality in the left occipital lobe (red arrow) and the left temporal lobe (white arrow). (b) MRI obtained 2 days later with the increase in size of signal abnormality involving the right frontal cortex (yellow arrow) and multiple areas of signal abnormality in the right frontal, right occipital (red arrow), and left temporal lobes (white arrow). (c) Ten days from initial presentation, there were new and increase in previously known long TR hyperintensities involving the cortical (yellow arrow) and subcortical (red and white arrows) white matter. Given the short interval imaging findings, an infectious etiology was favored as the cause of the patient's symptoms.
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A magnetic resonance imaging (MRI) of the brain with contrast was obtained, and it showed a nonspecific focal area of increased signal involving the right frontal cortex (Figure 1(a)). His neurological status continued to decline and repeat MRI brain showed new and increase in size of previously known scattered hyperintensities with associated rim enhancement (Figure 1(c)).
Microphotographs of autopsy brain sections. Hematoxylin and eosin stain. (a) A low-power view shows areas of parenchymal hemorrhage and necrosis with mixed inflammation, x10 objective. (b) A higher power view demonstrates amebic trophozoites and occasional cysts, x20 objective. (c) At high power, numerous amebic trophozoites can be seen intermixed with inflammatory cells and occasional multinucleated giant cells (yellow arrow), x40 objective. (d) The amebae (black arrow) are prominent around vessels (V), x40 objective.
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Microscopic findings revealed parenchymal necrosis with mixed inflammation, amebic trophozoites, and occasional cysts (Figures 2(a) and 2(b)). The amebas were prominent around vessels, and occasional multinucleated giant cells were seen (Figures 2(c) and 2(d)).