Ameboma: an unusual cause of gastrointestinal bleeding during severe leptospirosis

Abstract

BackgroundSevere leptospirosis occurs mainly in a tropical environment and includes icterus, acute renal failure and hemorrhages. These bleedings, which are mainly a consequence of acute homeostatic disturbances, can also reveal simultaneous diseases. Coinfections with other tropical diseases have been previously reported during leptospirosis. To our knowledge, invasive amebiasis, which can induce gastrointestinal bleedings, has never been described in the course of severe leptospirosis.Case presentationIn this report, we describe a case of a 60 year-old man living in Reunion Island (Indian Ocean, France) admitted to our intensive care unit for severe Leptospira interrogans serovar icterohaemorrhagiae infection with neurological, renal, liver and hematological involvement. Two lower gastrointestinal bleedings occurred 7 and 15 days after admission. The first episode was promoted by hemostatic disturbances while the second bleeding occurred during low-dose heparin therapy. Colonoscopy revealed a pseudo-tumoral inflammatory mass of the recto-sigmoid junction. Histological examination found trophozoites inside mucinous exudate suggestive of Entamoeba histolytica. Amoebic serology was strongly positive whereas careful detection of cysts or trophozoites on saline-wet mount was negative in three consecutive samples of stools. Amoxicillin followed by metronidazole therapy, combined with supportive care, led to an improvement in the clinical and biological patient’s condition and endoscopic appearances.ConclusionClinicians should be aware that gastrointestinal bleeding during severe leptospirosis could not solely be the consequences of hemostatic disturbances. Careful endoscopic evaluation that may reveal curable coinfections should also be considered.

Epidemiology of Leptospirosis in Africa: A Systematic Review of a Neglected Zoonosis and a Paradigm for ‘One Health’ in Africa

“…A wide range of clinical manifestations were reported including febrile illness, jaundice, meningitis, and acute respiratory distress syndrome. Case reports described confirmed or probable acute leptospirosis in patients in South Africa (n = 6) [ 43 , 47 , 54 , 57 , 65 , 71 ], Gabon (n = 3) [ 48 , 62 , 76 ], Morocco (n = 3) [ 50 , 52 , 53 ], Algeria (n = 1) [ 32 ], Mali (n = 1) [ 51 ], Réunion (n = 1) [ 75 ], and Senegal (n = 1) [ 60 ]. With the exception of Réunion and Senegal, case reports were the only eligible data on acute human leptospirosis from these countries.…”

Cholemic Nephropathy as Cause of Acute and Chronic Kidney Disease. Update on an Under-Diagnosed Disease

“…The causes of sHyb most frequently reported result from drug-induced cholestasis, liver cirrhosis, obstructive jaundice and malignant cholangiocarcinoma [64], alcoholic hepatitis, severely cholestatic liver graft, organ failure secondary to infections, sepsis, all conditions that could be associated with CN [17,21,22,24,46,48,[63][64][65][66]. The majority of cases reported serum bilirubin levels above 20 mg/dL with peaks of 58 mg/dL in one of the first case described in literature, highlighting the severity of hyperbilirubinemia [67].…”

“…The cases of AKI described in the context of sHyb usually correspond to the most severe cases, associated to the higher values of sCr reported or to the need for dialysis [3,16,48,[63][64][65][66][67][68][69][70][71][72][73][74].…”

“…The renal biopsy, however, was diagnostic for CN. Legris T et al [65] have described a patient with Leptospira interrogans serovar with sHyb and AKI. Urinalysis was not performed nor a kidney biopsy.…”

“…Further cases describe patients with oligoanuric AKI in the context of sHyb secondary to drug-induced cholestasis and infections, interpreting the occurrence of AKI as caused by sepsis but no bile casts on urine sediment was investigated and CN nephropathy was not hypothesized [65].…”