Successful treatment of cutaneous Acanthamoeba castellanii infection with miltefosine in a patient with chronic lymphocytic leukaemia on ibrutinib

Joanne S.K. Teh, Patrick C.K. Tam, Paul R. Badenoch, Penelope J. Adamson, Catriona Brennan, Gillian Marshman, David L. Gordon

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

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).
Original languageEnglish
Pages (from-to)539-541
Number of pages3
JournalJournal of Antimicrobial Chemotherapy
Volume77
Issue number2
DOIs
Publication statusPublished - Feb 2022

Keywords

  • Acanthamoeba
  • Acanthamoeba castellanii
  • miltefosine
  • chronic lymphocytic leukaemia
  • Ibrutinib
  • Immunocompromised patients
  • tyrosine kinase inhibitor
  • trophozoites

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