Abstract
Acanthamoeba infections pose a diagnostic and therapeutic challenge for clinicians. Early recognition, prompt diagnosis and rapid initiation of treatment are essential to improve patient survival.
We report the case of a 70-year-old immunocompromised man with CLL treated with the Bruton’s tyrosine kinase inhibitor, ibrutinib, who presented with tender, erythematous, subcutaneous nodules measuring 5–10 mm, evolving over 2 months (Figure 1a). A skin biopsy revealed histiocytic and lymphocytic inflammation with ulceration and necrosis (Figure 1b). Scattered organisms seen in the haematoxylin and eosin and periodic acid-Schiff-diastase stains were consistent with amoebic trophozoites (Figure 1c). Trophozoites were subsequently cultured on non-nutrient agar plates overlaid with Escherichia coli. The appearance of double-walled cysts was suggestive of Acanthamoeba. Axenic growth in broth was achieved in PYNFH medium (ATCC® 327-X™). DNA was extracted from pelleted trophozoites and a fragment of the 18S rRNA gene was amplified using primers JDP1 and JDP2.1 A 461-base consensus sequence was deposited into GenBank (Accession No. MT007263). Our isolate demonstrated >99% identity with Acanthamoeba castellanii (ATCC 30011) (refer to the Supplementary data available at JAC Online).
We report the case of a 70-year-old immunocompromised man with CLL treated with the Bruton’s tyrosine kinase inhibitor, ibrutinib, who presented with tender, erythematous, subcutaneous nodules measuring 5–10 mm, evolving over 2 months (Figure 1a). A skin biopsy revealed histiocytic and lymphocytic inflammation with ulceration and necrosis (Figure 1b). Scattered organisms seen in the haematoxylin and eosin and periodic acid-Schiff-diastase stains were consistent with amoebic trophozoites (Figure 1c). Trophozoites were subsequently cultured on non-nutrient agar plates overlaid with Escherichia coli. The appearance of double-walled cysts was suggestive of Acanthamoeba. Axenic growth in broth was achieved in PYNFH medium (ATCC® 327-X™). DNA was extracted from pelleted trophozoites and a fragment of the 18S rRNA gene was amplified using primers JDP1 and JDP2.1 A 461-base consensus sequence was deposited into GenBank (Accession No. MT007263). Our isolate demonstrated >99% identity with Acanthamoeba castellanii (ATCC 30011) (refer to the Supplementary data available at JAC Online).
Original language | English |
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Pages (from-to) | 539-541 |
Number of pages | 3 |
Journal | Journal of Antimicrobial Chemotherapy |
Volume | 77 |
Issue number | 2 |
DOIs | |
Publication status | Published - Feb 2022 |
Keywords
- Acanthamoeba
- Acanthamoeba castellanii
- miltefosine
- chronic lymphocytic leukaemia
- Ibrutinib
- Immunocompromised patients
- tyrosine kinase inhibitor
- trophozoites