{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T15:10:42Z","timestamp":1789139442969,"version":"build-2803163510"},"reference-count":25,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,7,24]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:p>\n                    <jats:italic>Balamuthia mandrillaris<\/jats:italic>\n                    is a rare and difficult-to-diagnose infection with high mortality. We present the case of an immunocompetent toddler presenting with central nervous system (CNS) vasculitis. He was initially diagnosed with Takayasu arteritis and had an initial period of improvement following immunosuppressive therapy. Subsequently, he had rapid decompensation with diffuse intracranial lesions progressing to severe neurological injury and compassionate extubation. Metagenomic sequencing of the CSF and pathology and PCR from brain biopsy were positive for\n                    <jats:italic>B. mandrillaris<\/jats:italic>\n                    . To our knowledge, this is the first case of\n                    <jats:italic>Balamuthia<\/jats:italic>\n                    presenting as a mixed vessel CNS vasculitis and highlights the importance of consideration of this infection in cases of vasculitis, particularly in mixed vessel disease. It further demonstrates the potential use of newer diagnostics, namely CSF metagenomic testing and amoeba PCR, in earlier diagnosis and treatment.\n                  <\/jats:p>","DOI":"10.1136\/bcr-2026-275051","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T12:40:17Z","timestamp":1786538417000},"page":"e275051","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["<i>Balamuthia mandrillaris<\/i>\n                    presenting as central nervous system vasculitis in a young child"],"prefix":"10.1136","volume":"19","author":[{"given":"Emily Anne","family":"Carsello","sequence":"first","affiliation":[{"name":"Department of Pediatrics, University of Washington, Seattle, Washington, USA"},{"name":"Pediatric Neurology, Seattle Children\u2019s Hospital, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katelyn","family":"Liston","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Washington, Seattle, Washington, USA"},{"name":"Division of Rheumatology, Seattle Children\u2019s Hospital, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon","family":"Maust","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Washington, Seattle, Washington, USA"},{"name":"Infectious Disease, Seattle Children\u2019s Hospital, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gail","family":"Deutsch","sequence":"additional","affiliation":[{"name":"Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA"},{"name":"Laboratories, Seattle Children\u2019s Hospital, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Wright","sequence":"additional","affiliation":[{"name":"University of Washington School of Medicine, Seattle, Washington, USA"},{"name":"Pediatric Neuroradiology, Seattle Children\u2019s Hospital, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Wong","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Seattle Children\u2019s Hospital, Seattle, Washington, USA"},{"name":"University of Washington School of Medicine, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsey","family":"Morgan","sequence":"additional","affiliation":[{"name":"Pediatric Neurology, Seattle Children\u2019s Hospital, Seattle, Washington, USA"},{"name":"University of Washington School of Medicine, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Surabhi","family":"Vora","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Washington, Seattle, Washington, USA"},{"name":"Infectious Disease, Seattle Children\u2019s Hospital, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"2026091107251500000_19.8.e275051.1","unstructured":"Centers for Disease Control and Prevention . 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