Abstract：
An 82-year-old man, who was healthy and had worked as a farmer, experienced worsening neurological symptoms over a seven-month period, which eventually caused his death. Multiple fluctuating brain lesions were detected radiographically. Clinically, sarcoidosis was ranked high among the differential diagnoses because of the presence of skin lesions showing granulomatous inflammation, confirmed by biopsy. The patient\'s cerebrospinal fluid was also examined, but no definitive diagnosis was made while he was alive. An autopsy revealed multiple granulomatous amebic encephalitis lesions in the brain. Genetic and immunohistochemical analyses identified Balamuthia (B.) mandrillaris, a free-living ameba, which resides in soil and fresh water, as the causative organism. A retrospective examination revealed B. mandrillaris in the biopsied skin as well as cerebrospinal fluid, strongly suggesting that the ameba had spread into the brain percutaneously. Few studies have detailed the cutaneous pathology of B. mandrillaris infections. In general, granulomatous amebic encephalitis is extremely difficult to diagnose without autopsy, but the present case provides a clue that could allow similar cases to be diagnosed earlier; that is, the presence of skin lesions.
摘要：
一个82岁的老人,他很健康，当过农民，经历了七个月的神经症状恶化，最终导致了他的死亡.影像学检查发现了多个波动的脑部病变。临床上,结节病在鉴别诊断中排名很高，因为存在表现为肉芽肿性炎症的皮肤病变，活检证实。还检查了病人的脑脊液，但在他活着的时候没有做出明确的诊断.尸检显示大脑中有多个肉芽肿性阿米巴脑炎病变。遗传和免疫组织化学分析确定了Balamuthia（B.)mandrillaris，一个自由生活的Ameba,居住在土壤和淡水中，作为致病生物。回顾性检查显示，活检皮肤和脑脊液中的B.mandrillaris，强烈暗示阿米巴已经经皮扩散到大脑。很少有研究详细说明曼肩芽孢杆菌感染的皮肤病理学。总的来说,肉芽肿性阿米巴脑炎在没有尸检的情况下极难诊断，但是目前的病例提供了一个线索，可以让类似的病例更早地被诊断出来；也就是说，皮肤损伤的存在。
