Fatal Case of Balamuthia Amoebic Encephalitis in A Patient with MOG Antibody-Associated Disease

A 52-year-old female patient with a background of myelin oligodendrocyte glycoprotein antibody-associated disease under immunosuppression presented with headache and confusion, requiring hospitalization. Neurological examination revealed drowsiness, stiff neck, and elevated intracranial pressure in cerebrospinal fluid, accompanied by marked increases in white blood cells and protein levels. The patient experienced convulsions on the first night of admission. MRI identified nodular lesions surrounding edema in bilateral occipital lobes, the posterior horn of the left lateral ventricle, and the left frontal lobe. Within 48 hours, the patient progressed to coma and respiratory failure. On the third day, CSF next-generation sequencing confirmed Balamuthia mandrillaris infection. The ornidazole, azithromycin meropenem, vancomycin combined with voriconazole were administered to the patient for anti-infective therapy. Given the severe aggravation of the condition and poor prognosis of the disease, the patient's family requested termination of treatment, and she died a moment later when artificial life support was withdrawn.