Soil and freshwater-dwelling amoebae may opportunistically infect the skin and evoke a granulomatous dermatitis that camouflages their underlying morphology. Amoebic infestations are incredibly rare in the U.S., predominantly occurring in the young, elderly, and immunocompromised. Sadly, because diagnosis is difficult and unsuspected, most cases are diagnosed at autopsy. The following case is of a healthy 84-year-old man with a non-healing nodulo-ulcerative cutaneous lesion on his left forearm that appeared following a gardening injury. Lesional punch biopsies repeatedly showed non-specific granulomatous inflammation with no pathogens evident histologically or by culture. Histopathologic diagnosis was made five months after initial presentation via identification of amoebic trophozoite forms in tissue from a large excisional specimen. Anti-amoebic therapy was initiated immediately. The patient experienced mental status changes three days following lesion excision, with evidence of a cystic mass in the left medial parieto-occipital lobe by CT. Both intraoperative brain biopsies and cutaneous tissue samples tested positive for Balamuthia mandrillaris by indirect immunofluorescent antibody assay performed at the Centers for Disease Control. The patient achieved a full recovery on a triple antibiotic regimen. Clinical suspicion and thorough histopathologic analysis may determine the difference between survival and death for a patient presenting with a treatment-refractory localized granulomatous lesion.

PLEXUS is a student-organized publication that showcases artwork by UCI School of Medicine students, physicians, faculty, staff and patients. True to its name, PLEXUS aspires to connect those who seek to heal and to be healed through the unifying language of art.

In 2015, PLEXUS invited submissions to complement our theme of ‘At the Intersection of Loss and Restoration”. The PLEXUS team was astounded by the depth and richness of the pieces submitted, and we thank each and every one of our submitters for their time and thought. Additionally, please find our multimedia submissions on our website, www.uciplexus.com. Previous publications and submissions are available online as well.

We would like to congratulate this year’s winners of the medical student writing competition. 1st: Kyle Barbour, MS1 “Two Months,” 2nd: Leigh Goodrich, MS1 “That Good Night,” and 3rd: Kimberly Vu, MS1 “The First of Many Patient Progress Notes”.

Thank you to our wonderful editors, staff and faculty for their support in making this year’s edition possible. We would like to give special thanks to our faculty advisor, Dr. Johanna Shapiro and Dr. Ellena Peterson, Associate Dean of Admissions and Outreach - this book would not have been possible without your guiding hands.

We hope you enjoy PLEXUS 2015 – At the Intersection of Loss and Restoration.

Editors-In-Chief: Kevin Gustafson, Jiwon Shin

Digital Editor-In-Chief: Neil Saez

Creative Arts: Evelyn Hoover, Katherine Stern, Katie McDaniel, Carolyn Fall, Kyle Barbour, Wilfred Manzano

Layout, Design & Visuals: Ben Nguyen, Austin Momii, Christopher Vo, Michael Bernaba

Marketing And Outreach: Helene Nepomuceno, Tiffany Pham

Website Design: Austin Momii, Christopher Vo

Winners of PLEXUS Student Writing Competition made possible by UCISOM Humanities Department

1st Place Winner: Kyle Barbour

2nd Place Winner:  Leigh Goodrich

3rd Place Winner: Kimberly Vu

To contribute to PLEXUS or to request a PLEXUS exhibit at your event, please visit www.uciplexus.com.