Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2021; 9(15): 3726-3732
Published online May 26, 2021. doi: 10.12998/wjcc.v9.i15.3726
Fulminant amebic colitis in a patient with concomitant cytomegalovirus infection after systemic steroid therapy: A case report
Naoki Shijubou, Toshiyuki Sumi, Koki Kamada, Takeyuki Sawai, Yuichi Yamada, Tatsuru Ikeda, Hisashi Nakata, Yuji Mori, Hirofumi Chiba
Naoki Shijubou, Toshiyuki Sumi, Koki Kamada, Yuichi Yamada, Hisashi Nakata, Yuji Mori, Department of Respiratory Medicine, Hakodate Goryoukaku Hospital, Hakodate 040-8611, Japan
Naoki Shijubou, Toshiyuki Sumi, Koki Kamada, Takeyuki Sawai, Hirofumi Chiba, Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
Tatsuru Ikeda, Department of Pathology and Diagnosis, Hakodate Goryoukaku Hospital, Hakodate 040-8611, Japan
Author contributions: All authors contributed equally to this work; writing, reviewing and editing.
Informed consent statement: Written permission for publication of this case report and the accompanying images was obtained from the patient’s wife.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Naoki Shijubou, MD, Doctor, Department of Respiratory Medicine, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku-Cho, Hakodate-shi, Hakodate 040-8611, Japan. shjibou.1229@gmail.com
Received: January 6, 2021
Peer-review started: January 6, 2021
First decision: January 24, 2021
Revised: February 2, 2021
Accepted: March 20, 2021
Article in press: March 20, 2021
Published online: May 26, 2021
Abstract
BACKGROUND

Amebic colitis is an infection caused by Entamoeba histolytica and most commonly observed in regions with poor sanitation. It is also seen as a sexually transmitted disease in developed countries. While amebic colitis usually has a chronic course with repeated exacerbations and remissions, it may also manifest as a fulminant form that rapidly progresses and leads to severe, life-threatening complications, such as intestinal perforation, peritonitis, and sepsis, that have a high mortality rate.

CASE SUMMARY

A 68-year-old man was admitted to our hospital with chest pain and acute dyspnea. He was diagnosed with acute coronary syndrome, acute heart failure, and bacterial pneumonia. His respiratory condition worsened despite receiving intensive care and intravenous antibiotics. On the fifth day of hospitalization, he was diagnosed with acute respiratory distress syndrome and was started on steroid therapy. He subsequently developed bloody stools and was diagnosed with cytomegalovirus (CMV) enterocolitis based on biopsy results and a peripheral blood CMV pp65 antigenemia test result. Although we started antiviral therapy with ganciclovir, which was successful in reducing his antigen titers, he continued to have bloody diarrhea. Three weeks after initiation of ganciclovir therapy and six weeks after his admission, the patient died from intestinal perforation. We only posthumously diagnosed him with amebic colitis and CMV enterocolitis based on autopsy findings of transmural necrosis of the entire colon with massive ameba infiltration.

CONCLUSION

We urge clinicians to consider Entamoeba histolytica infection if severe colitis progresses after steroid therapy. Preemptive treatment is recommended then.

Keywords: Amebiasis, Intestinal, Colitis, Cytomegalovirus, Glucocorticoids, Perforation, Case report

Core Tip: The fulminant form of amebic colitis leads to severe, life-threatening complications such as intestinal perforation, peritonitis, and sepsis. We missed the diagnosis in a patient on steroid therapy who had a positive cytomegalovirus antigen test result. A high index of suspicion for possible Entamoeba histolytica infection is required. This is particularly relevant in patients with severe colitis that progresses after steroid therapy. We recommend preemptive treatment, even without a definite diagnosis, because of the high mortality rate.