A healthy toddler in Washington state became sick without warning. He vomited, grew lethargic, and developed weakness on his right side. Then came a headache, a fever, and difficulty swallowing. At one point he stopped breathing. His condition kept getting worse after doctors admitted him to the hospital.
It took more than 30 days to identify the cause. By then, the damage was permanent.
According to Ars Technica, the boy was infected with an ultra-rare amoeba that is known for destroying brain tissue. The pathogen was first identified in 1986, found in the brain of a monkey that died at the San Diego Zoo. In the four decades since, only about 200 human cases have been recorded worldwide. Roughly 90 percent of those cases have been fatal.
What made this case especially difficult was that the infection looked different from what the medical literature describes. The signs that doctors typically use to identify this pathogen were either absent or misleading, sending the medical team down the wrong path. It was not until more than a month into treatment that they finally reached the correct diagnosis.
By that point, the toddler had suffered profound and irreversible brain injuries. Therapy had no effect. His parents made the decision to remove his breathing tube. An autopsy confirmed the infection. It showed that the boy had suffered a severe stroke, that the blood vessels in his brain had become necrotic, and that his brain tissue was filled with amoebas.
His doctors at Seattle Children's Hospital published a case report on Wednesday in BMJ Case Reports. The report walks through where the diagnostic process went wrong and what clinicians should watch for in future cases. The boy's parents agreed to have his case published in hopes that it leads to earlier diagnoses for other patients.
The infection is known for being missed. Because it is so rare, many physicians never encounter it. Initial symptoms can look like many other conditions, and the window for effective treatment is narrow. The Seattle case shows how quickly that window can close.
