

Of all the known ways to get an Acanthamoeba infection, nasal rinsing was the most likely one in the man’s case. The man had nasal polyps and used sinus rinses to alleviate his symptoms. However, his symptoms didn’t start in his nasal passages—they started on his legs. There, red nodules formed and progressed to develop dark centers. Some became deep ulcers, while others became necrotic, turning to black scabs. Then began erupting on his trunk, arms, and neck. Catching a killer Before his transfer to Yale, doctors elsewhere tried to identify the mysterious cause, doing multiple biopsies of his diseased skin. Tests were negative for bacterial or fungal pathogens. But they showed his blood vessels were inflamed and full of clumps of immune cells. Doctors worried that his immune system was attacking his blood vessels, causing the necrotic lesions. So, they put him on immunosuppressant drugs. But his condition only worsened, and the lesions only progressed. When he arrived at Yale, he had a fever and high heart rate, and appeared frail. He had lost 16 pounds and was drowsy and confused. He was blanketed in lesions. The Yale doctors noted that the lesions began after he returned from Florida,
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