Unusual presentation of Multiple nerve palsies with Granulomatous encephalitis Due to Acanthamoeba species

Acanthamoeba spp is one of the common protozoa in soil, usually found in fresh water and other habitats. We are presenting a case of Granulomatous amoebic encephalitis presented with unusual symptoms of third, fourth, sixth, and seventh nerve palsy with diplopia, ptosis, and migraine. Differential diagnosis of tuberculous (TB) meningitis was initially considered but was ruled out by CSF TB PCR. There was no history of exposure to sources such as fresh water ponds and contaminated swimming pools. CSF wet mount and culture confirmed the diagnosis of Acanthamoeba spp. Specific antiparasitic therapy was started and patient improved with successful resolution of symptoms.