Severe amoebic colitis in an HIV-infected male patient

Description

A previously healthy Japanese man aged 67 years was admitted into our hospital after presenting with fever, abdominal pain and watery diarrhoea (occasionally bloody) for 2 weeks. At presentation, he had a fever of 38.9°C and diffuse abdominal tenderness. His white cell count was 7440/μL, C reactive protein 22.18 mg/dL, serum albumin 1.8 g/dL, potassium 2.9 mmol/L and blood urea nitrogen was 26.5 mg/dL. Abdominal CT revealed pancolitis with mild splenomegaly but no hepatic lesions. Stool analysis and culture was negative for pathogenic bacteria, Clostridium difficile and tuberculosis.

After conservative treatment with intravenous drip for 2 days, a sigmoidoscopy was performed. Multiple surface to deep ulcerations with yellowish exudate was observed in the rectosigmoid region (figure 1A). Mucosal biopsy revealed acute colitis with the presence of haemophagocytic amoebic trophozoites (figure 2, arrows). Microscopic examination of the patient's stool also confirmed the presence of Entamoeba histolytica trophozoites and amoebic serology was...

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