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Fig. 4 | Genome Medicine

Fig. 4

From: Clinical metagenomic identification of Balamuthia mandrillaris encephalitis and assembly of the draft genome: the continuing case for reference genome sequencing

Fig. 4

MRI and histopathology from a 15-year-old patient with a fulminant acute encephalitis. a A hospital day (HD) 1 coronal T2-weighted MR image, demonstrating a hemorrhagic lesion with surrounding edema within the superior left frontal lobe (left panel, white arrow) and left occipital lobe (right panel, white arrow). b A HD 5 contrast-enhanced T1-weighted MR image, revealing enlargement of the pre-existing left frontal lobe lesion (left panel, white arrow), as well as interval development of numerous additional rim-enhancing lesions in multiple regions (right panel, white arrows). c 20× (left and right panels) and 100× fields of view (right panel, inset) of a brain biopsy specimen from the patient demonstrating numerous viable, large amoebae (black arrows), with abundant basophilic vacuolated cytoplasm, round central nuclei, and prominent nucleoli, consistent with Balamuthia mandrillaris. There were areas of extensive hemorrhagic necrosis accompanied by a polymorphic inflammatory cell infiltrate including neutrophils and eosinophils (right panel)

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