Hidden in Granulomatous Inflammation: Histopathologic Challenges of Cutaneous <i>Balamuthia mandrillaris</i> Infection—A Canadian Case Report
Bibliographic record
Abstract
Balamuthia mandrillaris is a rare cause of cutaneous amebiasis that can progress to central nervous system infection, almost always resulting in death. It is a free-living, opportunistic ameba found globally in dust, soil, and freshwater that can infect people of all ages regardless of the status of the host immune system. Herein, we report a case of B. mandrillaris infection in Canada in an 83-year-old man presenting to the hospital with altered mental status and a chronic wound of 4-year duration. A skin biopsy of the chronic wound revealed extensive dermal granulomatous and mixed inflammatory infiltrate with abundant multinucleated giant cells. Inspection of multiple level sections revealed structures concerning for amebic trophozoites. After the patient's death, lesional tissue from the skin and brain was sent to the Centers for Disease Control (CDC) for further subtyping, which confirmed B. mandrillaris as the causative organism. This case raises awareness for this organism as a possible cause of cutaneous infections and highlights the necessity for dermatopathologists and pathologists alike to have a heightened suspicion for amebic infections when non-specific granulomatous inflammation is identified in the skin.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.003 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".