Jornal de relatos de casos clínicos

A Case of Fulminant Amebic Colitis Diagnosed after Colonic Resection

Abstract

Tatsuya Ishii, Nobuhiro Takeuchi, Masanori Takada, Akihito Otsuka and Yusuke Nomura

Here, we report a case of fulminant amebic colitis diagnosed after colonic resection in a 66-year-old male who visited our hospital complaining of prolonged fever and consistent pain in the right abdomen. The patient had neither watery nor bloody stool. Laboratory data revealed increased white blood cell counts (15,900 cells/μl) and high levels of C-reactive protein (10.3 mg/dl). Contrast enhanced computed tomography revealed remarkably hypertrophic and edematous lesions in the right-sided colon. Stool culture revealed no pathogens. The patient was suspected to have infectious colitis; thereafter, the antibiotic flomoxef sodium (3 g/day) was administered. Colonoscopy revealed a circumferential white coat and stripped mucosal lesions in the right-sided colon; thereafter, ischemic colitis or enterohemorrhagic Escherichia coli colitis was the differential diagnosis. When the general condition of the patient and their inflammatory response deteriorated, surgical treatment was adopted. Surgical findings revealed a rightsided necrotizing colon and yellowish ascites, which was later found to contain Enterococcus faecalis and grampositive bacillus. Pathological findings revealed the presence of trophozoites of Entamoeba histolytica. Consequently, fulminant amebic colitis was diagnosed. The postoperative course was uneventful, and the patient was discharged on postoperative day 18.