University of Kentucky Lexington, KY, United States
Priya Abhyankar, MD1, Lucas L. Roy, MD1, Courtney Perry, DO2 1University of Kentucky, Lexington, KY; 2University of Kentucky College of Medcine, Lexington, KY
Introduction: Entamoeba histolytica is a protozoan that can cause amoebic colitis characterized by the gradual onset of weight loss, diarrhea, abdominal pain, and bloody stools. Most infections are asymptomatic, but symptoms may occur years after travel to an endemic area. We present a patient with a history of treated amoebic colitis presenting with 18-pound weight loss, abdominal pain, and constipation found to have recurrence of amoebic colitis.
Case Description/Methods: A 74-year-old male with past medical history of amoebic colitis seven years ago presented with a one-month history of 18-pound weight loss, abdominal pain, and constipation. His symptoms resolved without intervention, but the patient was referred to gastroenterology as he was due for surveillance colonoscopy. He was first diagnosed with amoebic colitis after returning from the Philippines seven years ago. He was asymptomatic at that time and completed a 7-day course of antibiotics. He reported no travel to endemic areas since that time.
Colonoscopy revealed patchy mucosal ulcerations in the cecum, appendiceal orifice, and ileocecal valve. Biopsies were morphologically compatible with entamoeba histolytica. He was treated with ten days of metronidazole, 500 mg three times daily, followed by seven days of paromomycin, 1000 mg three times daily. He remained asymptomatic.
Discussion: Recurrence of amoebic colitis is rarely seen but should be part of the differential diagnosis for abdominal pain and weight loss in patients with any history of travel to endemic areas or with prior treatment for amoebic colitis. Treatment failure has been reported in up to 59% of patients treated with metronidazole. Treatment with metronidazole should be followed by an anti-luminal agent, such as paromomycin, to eradicate potential intestinal reservoirs. An asymptomatic carrier state is common and may last several years. Therefore, resolution of symptoms should not be used as evidence of eradication. Repeat stool testing by stool antigen or PCR should be done following treatment to ensure eradication.
Patients with amoebic colitis can present similarly to inflammatory bowel disease (IBD). It is important to gather a complete travel history--including remote travel to endemic areas--as fulminant amoebic colitis can occur if misdiagnosed as IBD and treated with corticosteroids.
Disclosures: Priya Abhyankar indicated no relevant financial relationships. Lucas Roy indicated no relevant financial relationships. Courtney Perry indicated no relevant financial relationships.
Priya Abhyankar, MD1, Lucas L. Roy, MD1, Courtney Perry, DO2. P2288 - A Case of Recurrent Amoebic Colitis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.