Disseminated <i>Acanthamoeba</i> Infection with Necrotic Skin Lesions and Granulomatous Vasculitis, United States

An elderly man, on dupilumab therapy for asthma and sinus polyposis, sought care for necrotic skin lesions. Biopsy revealed granulomatous vasculitis and he received immunosuppressive therapy but worsened. We diagnosed an Acanthamoeba infection that was treated with multidrug therapy including nitroxoline. Clinicians should be aware of this rare etiology for infectious vasculitis.