Wang Hui, Kanthan Rani
Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, S7N 0W8, Canada.
Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, S7N 0W8, Canada.
Pathol Res Pract. 2020 Jan;216(1):152608. doi: 10.1016/j.prp.2019.152608. Epub 2019 Aug 19.
Amoebiasis, caused by the intestinal protozoan Entamoeba histolytica, though a relatively common parasitic disease in the tropical and subtropical regions, is uncommon in the developed countries. In these countries, as amoebic colitis shares similar clinical symptoms and endoscopic features with inflammatory bowel disease (IBD), these cases can be easily unrecognized and misdiagnosed. In this case report, we discuss the case of an adult patient with invasive intestinal amoebiasis, who was initially managed as Crohn's disease on corticosteroid treatment and subsequently rapidly deteriorated and developed multiple perforations in the colon and ileum. Despite total colectomy followed by resection of the small bowel, he died of multiple organ failure and sepsis within two months of his initial clinical presentation of diarrhea with abdominal pain. The learning point of this case is that invasive intestinal amoebiasis should be considered as a differential diagnosis at the first clinical adult presentation of IBD-like symptoms despite suggestive endoscopic findings of Crohn's like ulcers. Regardless of negative endoscopic biopsies, due to the low sensitivity of microscopic examination, serology test for antibody and molecular test for Entamoeba DNA are recommended for accurate detection and identification of Entamoeba species, especially in the high risk populations with recent travel to endemic zones and for patients with immunosuppression and comorbidities such as diabetes mellitus, tuberculosis, alcoholism, HIV/AIDS and in pregnant women. Amoebiasis should be completely ruled out prior to corticosteroid administration, to avoid severe complications such as fulminant intestinal amoebiasis which is associated with an inherently high mortality.
阿米巴病由肠道原生动物溶组织内阿米巴引起，虽然在热带和亚热带地区是一种相对常见的寄生虫病，但在发达国家并不常见。在这些国家，由于阿米巴结肠炎与炎症性肠病（IBD）具有相似的临床症状和内镜特征，这些病例很容易被漏诊和误诊。在本病例报告中，我们讨论了一名患有侵袭性肠道阿米巴病的成年患者的病例，该患者最初被当作克罗恩病进行皮质类固醇治疗，随后病情迅速恶化，结肠和回肠出现多处穿孔。尽管进行了全结肠切除术并切除了小肠，但他在最初出现腹泻伴腹痛的临床症状后两个月内死于多器官功能衰竭和败血症。该病例的经验教训是，尽管内镜检查发现有类似克罗恩病的溃疡，但在成年患者首次出现类似IBD的临床症状时，应将侵袭性肠道阿米巴病作为鉴别诊断考虑。无论内镜活检结果是否为阴性，由于显微镜检查的敏感性较低，建议进行抗体血清学检测和溶组织内阿米巴DNA分子检测，以准确检测和鉴定溶组织内阿米巴物种，特别是对于近期前往流行地区的高危人群以及患有免疫抑制和合并症（如糖尿病、结核病、酗酒、艾滋病毒/艾滋病）的患者以及孕妇。在使用皮质类固醇之前，应彻底排除阿米巴病，以避免出现严重并发症，如暴发性肠道阿米巴病，其死亡率本来就很高。
