Abstract
Acute fulminating necrotizing amoebic colitis is predominantly diagnosed in underdeveloped countries plagued with poor sanitation. Its prevalence in developed countries is largely attributable to returning travelers from the above-mentioned destinations. It is a disease that carries a high mortality rate, potentially confounded by suboptimal healthcare availability and expertise in underdeveloped regions. We describe a rare case of acute fulminant amoebic colitis in a developed country manifesting in an immunocompetent host with no travel history.
This patient is a middle-aged Singaporean male without recent travel history. He presented with abdominal pain, dysentery, vomiting and fever. Examination revealed abdominal distension and peritonism. Computed tomography (CT) demonstrated multiple hypodense hepatic lesions, pneumoperitoneum, hepatic flexure colonic perforation and mural thickening worst at sigmoid and transverse colon. Exploratory laparotomy revealed 4-quadrant feculent peritonitis with multifocal colonic perforation. Total colectomy and end-ileostomy was performed. Disseminated amoebiasis was diagnosed on histopathology of operative specimen and blood serology. He was treated with metronidazole and paromomycin and made a full recovery. Interval CT scan showed complete regression of liver lesions, while ileostomy output tested negative for Entamoeba histolytica.
Our case report serves to remind clinicians of the potentially catastrophic effects of corticosteroid initiation for the treatment of mistakenly diagnosed inflammatory bowel disease, and to keep amoebic colitis in mind as a rare, but possible differential when dealing with patients presenting with dysentery in a developed country.
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Ken Min Chin: conception and design, acquisition of data, analysis and interpretation of data, drafting the article and revising it critically for important intellectual content, final approval of the version to be published. Wee Liang En: analysis and interpretation of data, revising the article critically for important intellectual content, final approval of the version to be published. Emile Kwong-Wei Tan: analysis and interpretation of data, revising the article critically for important intellectual content, final approval of the version to be published. Chun Yuen Chow: acquisition of data, analysis and interpretation of data, drafting the article and revising it critically for important intellectual content, final approval of the version to be published. Yvonne Ying-Ru Ng: conception and design, acquisition of data, analysis and interpretation of data, drafting the article and revising it critically for important intellectual content, final approval of the version to be published.
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Chin, K.M., En, W.L., Tan, E.KW. et al. Acute Fulminant Necrotizing Amoebic Colitis with Multifocal Colonic Perforation in a Developed Country — a Case Report. SN Compr. Clin. Med. 5, 85 (2023). https://doi.org/10.1007/s42399-023-01422-2
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DOI: https://doi.org/10.1007/s42399-023-01422-2