Fulminant Necrotising Amoebic Colitis of Whole of Large Bowel: A Rare Complication of a Common Infectious Disease

Abstract

Background. Fulminant necrotising amoebic colitis (FulNAC) is an uncommon and grave complication of a very common infectious disease widely prevalent in tropical countries. In most of the cases reported, only a segment of large bowel was gangrenous. The involvement of the whole of the large bowel, as in our case, is very rare and has very high mortality ranging from 55% to 100%. Case Summary. A 50-year-old gentleman presented with an acute abdomen with a history of crampy abdominal pain and passage of blood mixed with mucous and loose stools. After resuscitation and investigations, the patient was taken up for laparotomy and the findings showed that the caecum was sloughed off and the entire large bowel had multiple perforations. Subtotal colectomy with ileostomy was performed. Histopathological examination showed evidence of pancolitis with multiple colonies of amoebic trophozoites. Discussion. Entamoeba histolytica is a protozoon that affects the large intestine and liver in humans. There can be various presentations of amoebiasis: asymptomatic infection (90%), symptomatic noninvasive infection (6–8%), acute amoebic colitis (dysentery), or fulminant colitis with perforation. FulNAC is an uncommon complication, difficult to diagnose and treat, and associated with a high mortality rate, ranging from 55% to 100%. Conclusion. It is important to consider the possibility of fulminant necrotising amoebic colitis (FulNAC) as an uncommon and fatal complication of amoebiasis, especially in tropical countries, where amoebiasis is prevalent. Early diagnosis and antiamoebic treatment, along with urgent aggressive surgical resection of the involved segment and exteriorization of the proximal and distal bowel ends, are shown to reduce mortality.

Necrotizing amebic colitis in an elder patient: an unexpected autopsy finding

“…The involvement of the whole large intestine, as observed in the present case, is sporadic and associated with high mortality. 10 , 25 The microscopic examination was crucial to disclose the infectious etiology by showing round organisms with 20-30 mm and intracytoplasmic erythrocytes at the ulcers’ edge, recognized as amebic trophozoites, confirming the diagnosis of invasive amebiasis. Although the three species of the entamoeba complex: Entamoeba histolytica , Entamoeba dispar , and Entamoeba moshkovskii, cannot be distinguished by morphology, the context of the lesions in the present case are highly suggestive of Entamoeba hystolytica as the etiologic agent.…”

“…It is associated with high mortality, even if recognized and treated appropriately. 10 , 12 , 13 Immunosuppression, pregnancy, and corticotherapy are risk factors associated with fulminant disease. 1 , 4 , 13 - 15 …”

“…6 If recognized and treated timely; amebiasis is a curable disease. [7][8][9][10] However, missed diagnosis may lead to potentially severe complications like intestinal perforation, peritonitis, hemorrhage, strictures, or obstruction. 4,7,11 Amebic liver abscesses occur in 3-9% of cases of intestinal amebiasis.…”

“…It is associated with high mortality, even if recognized and treated appropriately. 10,12,13 Immunosuppression, pregnancy, and corticotherapy are risk factors associated with fulminant disease. 1,4,[13][14][15] Although endemic in Brazil, there is a lack of national reports about the burden of amebiasis.…”

Acute fulminant amoebic colitis: A Case report

“…The most sensitive assay is indirect hemagglutination test, although in endemic areas positive results could represent prior infection. 7 Microscopic examination of feces to observe cysts has low sensitivity (25%–60%); however, better results are obtained with stool culture (Robinson’s), stool real-time polymerase chain reaction (sensitivity 79% and specificity 96%), and stool antigen detection (ELISA) (sensitivity 55%–100% and specificity 93%–100%). 3 , 5 In our patient, both the stool and serological studies were strikingly negative, which highlight the need of a high suspicion index of E. histolytica as the presumptive diagnosis in patients with acute abdomen in endemic areas.…”