The Great Masquerader: Acanthamoeba-Associated Myelopathy Mimicking Tropical Spastic Paraparesis

Acanthamoeba spp. typically causes Granulomatous Amoebic Encephalitis in immunocompromised hosts ¹ . We describe three immunocompetent patients who presented with progressive spastic quadriparesis to our hospital in Kerala, India. Two had parenchymal changes in the spinal cord, while one had normal neuroimaging. All were initially investigated for non-compressive myelopathy. Amoeba species-specific PCR examination of cerebrospinal fluid confirmed Acanthamoeba spp. in all patients and they responded to anti-amoebic therapy with significant clinical and biochemical improvement in CSF. Exposure routes included skin breach and nasal ablution. This case series clearly highlight that Acanthamoeba infection should be considered in the differential diagnosis of non-compressive myelopathy. CSF wet mount examination and molecular tests should be performed in all cases of potential parainfectious demyelination to prevent misdiagnosis as incurable neurodegenerative diseases.