Necrotizing granulomatous meningoencephalitis due to Balamuthia in an immunocompetent child

A 4-year-old boy presented with headache for 2 months. Neuroimaging revealed a partially calcified left parieto-occipital lesion suspicious for tumor (figure 1, A–C); biopsy showed necrotizing granulomatous meningoencephalitis. Postoperative MRI showed rapid progression (figure 1, D–F). He developed fever and seizures and died …