Acanthameba meningoencephalitis masquerading as neurocysticercosis

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Abstract
Neurocysticercosis is recognized with increasing frequency in North America, especially in the southwestern United States. The diagnosis usually is suspected in patients who present with seizures or other symptoms of a cranial mass and is considered likely in those in whom a computerized tomogram (CT) or magnetic resonance image of the head reveals a “ring-enhancing” lesion.1–6 Serologic tests are available at research, state and national laboratories to support the diagnosis. Some patients presenting with neurocysticercosis have parenchymal lesions associated with cerebral edema and intracranial hypertension.1 Such patients may be unresponsive to therapeutic intervention and die.4 In some patients with neurocysticercosis who are treated with praziquantel, an exacerbation of the inflammatory process around the lesions results in cerebral edema and clinical deterioration.7–12 In either situation the clinical course may be indistinguishable from other neurologic disorders characterized by progressive and rapid deterioration. We report a case of a fatal granulomatous amebic encephalitis in which the clinical presentation, radio-logic evaluation and cerebrospinal fluid serology all suggested neurocysticercosis.

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