Balamuthia mandrillaris is an amoeba that causes an uncommon but deadly encephalitis, referred to as granulomatous amoebic encephalitis (GAE). The highest incidence reported worldwide has occurred in America, and within the United States, it has been highest in the Southwest affecting predominantly children and young men of Hispanic ethnicity. Clinical presentation of GAE includes fever, headache, nausea, vomiting, lethargy, irritability, stiff neck, hallucinations, photophobia, and seizures. Our patient was a Hispanic male child living in Arizona. The patient presented at 3 years of age for severe encephalitis. Symptoms included difficulty with balance, gait, and sitting up and seizure-like activity. Initial CT showed an area of decreased density consistent with edema in the left frontoparietal lobe. Rapid progression was seen on further imaging over the length of the patient’s hospital stay revealing diffusion restriction, necrosis/blood products, edema, and hemorrhage. The patient expired from tonsillar herniation 22 days after the onset of initial symptoms and 4 days after admission to our institution. While there are multiple biochemical techniques that can test for B. mandrillaris, they are rarely employed for multiple reasons stemming from the rare occurrence of this infection. Balamuthia mandrillaris can cause a lethal brain infection. Because of the fatal nature of this infection, we propose 1) testing should be considered if a patient presents with progressing encephalitis on imaging and other pathogenic etiologies are ruled out and 2) the threshold to treat empirically should be low due to the fatal nature of the infection. Read More

Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024

Authors: Szymanski Kathryn, Pfeifer Cory, Friedman Neil, Kuwabara Michael

Keywords: amoeba, Balamuthia mandrillaris, brain infection

Kenny Caffey syndrome type 2 (KCS2) is a rare genetic syndrome affecting the bones, causing cortical thickening and medullary stenosis of tubular bones. Additional findings include short stature, delayed closure of anterior fontanelle, eye abnormalities, and hypoparathyroidism. Here we discuss a case of this rare disease. The patient was a 4-year-old male with history of intrauterine growth restriction, poor natal growth with relative macrocephaly, and abnormal skeletal findings. Genetic testing revealed a de novo variant of the FAM111A gene, most consistent with Kenny-Caffey syndrome type 2. The patient was followed in the bone dysplasia clinic and was noted to have growth delay (height < 1 percentile, z-score = -6 SD) and poor weight gain. Labs showed low IGF-1 (z-score = -2.5 SD), and growth hormone stimulation test revealed a peak of 9.8 ug/L. MR brain (age 4 years) showed 1) borderline Chiari I malformation, 2) small globes, 3) partially empty, shallow sella, and 4) enlarged posterior ventricular atria. Our patient demonstrated intracranial findings that may be unique when compared to the literature and/or related to the patient's skeletal abnormalities. As KCS2 is a rare disorder, diagnosis may be difficult. The findings presented in this case offer insight into both typical and novel findings that may aid in diagnostic accuracy and undoubtedly warrant further investigation. Read More

Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024

Authors: Szymanski Kathryn, Arnold Cerys, Dhatt Jovan, Pfeifer Cory

Keywords: Kenny Caffey Syndrome

Appendicitis is a common cause of acute abdominal pain requiring surgery in the pediatric population. For this reason, urgent and accurate diagnosis is critical. While ultrasound is the first line diagnostic modality, MRI has emerged as an important adjunct. The purpose of this presentation is to review the use of MRI for appendicitis in Children's hospitals from the perspectives of both the radiology departments and ordering providers using existing literature. Read More

Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024

Authors: Szymanski Kathryn, Wang Lucas, Arnold Cerys, Pfeifer Cory

Keywords: Appendicitis, MRI