Fatal brain infection associated with improper nasal lavage
Published in the International Journal of Infectious Diseases, the authors present a case of a 69-year old female who presented with a chronic nasal skin rash, a new onset focal seizure, and a cerebral ring-enhancing lesion after a year of improper nasal irrigation. Despite aggressive and novel anti-amoebic treatment, she succumbed to a fatal Balamuthia mandrillaris brain infection.

The patient was a 69-year-old female with a distant history of breast cancer. One year prior to diagnosis of brain infection, she developed a chronic sinus infection. The patient’s primary care physician prescribed her 800-160 mg sulfamethoxazole-trimethoprim BID in treatment of acute recurrent maxillary sinusitis which did not provide her symptom relief. Otolaryngology suggested that the patient use a saline irrigation to clear her sinuses.

While it is recommended that only sterile water or saline be used for these procedures, the patient used tap water. After a month of using non-sterile water for nasal lavage without success, she developed a quarter-sized red raised rash on the right side of the bridge of her nose and raw red skin on the nasal opening which was thought to be rosacea.

The biopsies demonstrated skin with mixed inflammation, giant cells, and rare non-necrotizing granulomas. The pathologists suggested a differential diagnosis of rosacea or granulomatous rosacea on all three occasions with additional considerations including ruptured folliculitis, infection, sarcoidosis, granuloma faciale, and perifollicular lymphogranuloma.

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