Acute meningoencephalitis with subdural empyema associated with Acanthamoeba in an immunocompetent individual

Abstract

Acanthamoeba-induced meningoencephalitis is a rare and frequently fatal condition. We describe a case of acute Acanthamoeba meningoencephalitis complicated by subdural empyema in a previously healthy 50-year-old man who presented with high-grade fever, neck stiffness and left-sided hemiparesis. Neuroimaging revealed a subdural collection in the right fronto-temporo-parietal region, while cerebrospinal fluid analysis demonstrated neutrophilic pleocytosis with trophozoites morphologically consistent with Acanthamoeba species. The patient underwent burr-hole evacuation of the subdural collection and was managed with antimicrobial therapy and supportive care. The patient achieved complete recovery and was discharged after 2 weeks. This case underscores the importance of considering Acanthamoeba as a potential etiological agent in meningoencephalitis, even among immunocompetent individuals and highlights the critical role of early diagnosis and timely intervention in improving clinical outcomes.