Primary Amebic Meningoencephalitis with Super-Refractory Status Epilepticus: A Dreadful Combination

Amebic encephalitis is a rare but lethal central nervous system infection caused by free-living amoebae. Primary amebic meningoencephalitis (PAM) presents like bacterial meningitis and have high mortality rate of above 90%, despite antimicrobial therapy. A 34-year-old gentleman presented to us with fever followed by generalized tonic-clonic convulsions. In view of status epilepticus, he was intubated and ventilated. Lumbar puncture was done and cerebrospinal fluid (CSF) cytology flagged possibility of fungal etiology and liposomal amphotericin was started. Patient was on propofol and ketamine infusion to which he responded slowly, suggesting super-refractory status epilepticus (SRSE). Possible autoimmune or parainfectious immune-mediated encephalitis were considered and ruled out. Polymerase chain reaction for amoebic etiology from CSF was reported positive for Naegleria species. Intravenous amphotericin deoxycholate was started, along with other drugs in a combination regimen. SRSE got controlled in a week of anesthetic agents, antiseizure medications, and intravenous immunoglobulin in addition to specific treatment for primary amoebic meningitis. PAM in itself is a fatal central nervous system infection, with very high mortality rate of over 97%. The fatal pathogenesis involving ameba’s rapid destruction of brain tissue and the host’s intense immune response is the usual culprit, but in this case, we had to confront, an unusual, unexpected dreaded medical emergency with high morbidity and mortality—SRSE. Publication History Article published online: 15 July 2026 © 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/) Thieme Medical and Scientific Publishers Private Limited A-13A, Graphix Tower 1, 6th floor, Sector 62, Noida 201309, Uttar Pradesh, India