Carboplatin/etoposide/meropenemFulminant amoebic colitis and lack of efficacy: case report A 64-year-old man developed fulminant amoebic colitis during treatment with carboplatin and etoposide for small-cell lung cancer (SCLC). Additionally, he exhibited lack of efficacy during treatment with meropenem for Peptostreptococcus infection [routes and time to reactions onset not stated; not all dosages stated].The man presented to the hospital with cough and right pleural effusion. After further investigations, he was diagnosed with SCLC. Thereafter, he started receiving treatment with carboplatin (AUC: 6 mgmL -1 min -1 ) and etoposide 100 mg/m -2 . On day 4, pneumothorax was observed, requiring chest tube drainage. He was empirically started on ampicillin/sulbactam on the day 6 for fever and right thoracic empyema. On day 8, he developed febrile neutropenia.The man treatment was changed to meropenem with filgrastim. Though his pleural effusion culture showed a meropenemsensitive Peptostreptococcus infection, no improvement was observed in his condition, and on day 19, he developed diarrhoea. On day 24, he developed bloody stools and abdominal pain. CT of abdomen showed small amount of ascites, intestinal retention, intussusception in the ileocecal region, and abscess in the left hepatic lobe. On day 25, a surgery was performed. An intraoperative findings showed extensive necrosis of the colon. He underwent colectomy and colostomy. After the operation, septic shock occurred and intensive care management was performed. His treatment with meropenem was switched to piperacillin/tazobactam, vancomycin and micafungin for possible catheter related blood stream infection of methicillin-resistant Staphylococcus aureus. On day 28, he developed portal vein thrombosis and was initiated on unspecified anticoagulation therapy. A pathological specimens revealed Entamoeba histolytica infection. Based on all these findings a diagnosis of amoebic colitis secondary to carboplatin and etoposide was made. He was treated with metronidazole and paromomycin. Later, his general condition improved without any complications.The man was re-initiated on reuced dose of carboplatin with etoposide for SCLC. However, no recurrence of amoebic dysentery was noted.
