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Multiple colonic and ileal perforations due to unsuspected intestinal amoebiasis-Case report and review.
Pathol Res Pract. 2020 Jan; 216(1):152608.PR

Abstract

Amoebiasis, caused by the intestinal protozoan Entamoeba histolytica, though a relatively common parasitic disease in the tropical and subtropical regions, is uncommon in the developed countries. In these countries, as amoebic colitis shares similar clinical symptoms and endoscopic features with inflammatory bowel disease (IBD), these cases can be easily unrecognized and misdiagnosed. In this case report, we discuss the case of an adult patient with invasive intestinal amoebiasis, who was initially managed as Crohn's disease on corticosteroid treatment and subsequently rapidly deteriorated and developed multiple perforations in the colon and ileum. Despite total colectomy followed by resection of the small bowel, he died of multiple organ failure and sepsis within two months of his initial clinical presentation of diarrhea with abdominal pain. The learning point of this case is that invasive intestinal amoebiasis should be considered as a differential diagnosis at the first clinical adult presentation of IBD-like symptoms despite suggestive endoscopic findings of Crohn's like ulcers. Regardless of negative endoscopic biopsies, due to the low sensitivity of microscopic examination, serology test for antibody and molecular test for Entamoeba DNA are recommended for accurate detection and identification of Entamoeba species, especially in the high risk populations with recent travel to endemic zones and for patients with immunosuppression and comorbidities such as diabetes mellitus, tuberculosis, alcoholism, HIV/AIDS and in pregnant women. Amoebiasis should be completely ruled out prior to corticosteroid administration, to avoid severe complications such as fulminant intestinal amoebiasis which is associated with an inherently high mortality.

Authors+Show Affiliations

Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, S7N 0W8, Canada. Electronic address: huw546@usask.ca.Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, S7N 0W8, Canada.

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

31564573

Citation

Wang, Hui, and Rani Kanthan. "Multiple Colonic and Ileal Perforations Due to Unsuspected Intestinal amoebiasis-Case Report and Review." Pathology, Research and Practice, vol. 216, no. 1, 2020, p. 152608.
Wang H, Kanthan R. Multiple colonic and ileal perforations due to unsuspected intestinal amoebiasis-Case report and review. Pathol Res Pract. 2020;216(1):152608.
Wang, H., & Kanthan, R. (2020). Multiple colonic and ileal perforations due to unsuspected intestinal amoebiasis-Case report and review. Pathology, Research and Practice, 216(1), 152608. https://doi.org/10.1016/j.prp.2019.152608
Wang H, Kanthan R. Multiple Colonic and Ileal Perforations Due to Unsuspected Intestinal amoebiasis-Case Report and Review. Pathol Res Pract. 2020;216(1):152608. PubMed PMID: 31564573.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multiple colonic and ileal perforations due to unsuspected intestinal amoebiasis-Case report and review. AU - Wang,Hui, AU - Kanthan,Rani, Y1 - 2019/08/19/ PY - 2019/06/29/received PY - 2019/08/16/revised PY - 2019/08/18/accepted PY - 2019/10/1/pubmed PY - 2020/11/25/medline PY - 2019/10/1/entrez KW - Bowel perforation KW - Entamoeba histolytica KW - Fulminant amoebic colitis KW - Intestinal amoebiasis KW - Mimicker of Crohn’s colitides SP - 152608 EP - 152608 JF - Pathology, research and practice JO - Pathol Res Pract VL - 216 IS - 1 N2 - Amoebiasis, caused by the intestinal protozoan Entamoeba histolytica, though a relatively common parasitic disease in the tropical and subtropical regions, is uncommon in the developed countries. In these countries, as amoebic colitis shares similar clinical symptoms and endoscopic features with inflammatory bowel disease (IBD), these cases can be easily unrecognized and misdiagnosed. In this case report, we discuss the case of an adult patient with invasive intestinal amoebiasis, who was initially managed as Crohn's disease on corticosteroid treatment and subsequently rapidly deteriorated and developed multiple perforations in the colon and ileum. Despite total colectomy followed by resection of the small bowel, he died of multiple organ failure and sepsis within two months of his initial clinical presentation of diarrhea with abdominal pain. The learning point of this case is that invasive intestinal amoebiasis should be considered as a differential diagnosis at the first clinical adult presentation of IBD-like symptoms despite suggestive endoscopic findings of Crohn's like ulcers. Regardless of negative endoscopic biopsies, due to the low sensitivity of microscopic examination, serology test for antibody and molecular test for Entamoeba DNA are recommended for accurate detection and identification of Entamoeba species, especially in the high risk populations with recent travel to endemic zones and for patients with immunosuppression and comorbidities such as diabetes mellitus, tuberculosis, alcoholism, HIV/AIDS and in pregnant women. Amoebiasis should be completely ruled out prior to corticosteroid administration, to avoid severe complications such as fulminant intestinal amoebiasis which is associated with an inherently high mortality. SN - 1618-0631 UR - https://www.unboundmedicine.com/medline/citation/31564573/Multiple_colonic_and_ileal_perforations_due_to_unsuspected_intestinal_amoebiasis_Case_report_and_review_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0344-0338(19)31313-5 DB - PRIME DP - Unbound Medicine ER -