Fulminant amoebic colitis associated with HIV infection; Report of a case

Abstract

A 37 year-old homosexual man admitted to our hospital with right lower abdominal pain and severe diarrhea in April 2002. Colonoscopy revealed extensive mucosal necrosis of the colon and rectum, and abdominal CT revealed multiple liver abscesses. As the serum test for anti-amoebic antibody was positive, we suspected amoebic colitis and amoebic liver abscesses. The patient was in a pre-immunodeficiency state, with a CD4 lymphocyte count of 220/ul. The abdominal pain suddenly worsened on tine day after the admission, and a CT revealed free air in the abdominal cavity and massive ascites. An emergency operation was performed under the suspected diagnosis of colonic perforation caused by fulminant amoebic colitis. We recognized a perforation in the cecum, and a cecostomy was carried out at the site of this perforation. One year later, the cecostomy was closed. The incidence of amoebic colitis associated with HIV infection has been increasing in Japan during the last ten years. We wish to emphasize the importance of early diagnosis and proper treatment to prevent fulminant amoebiasis and death. ©2008 The Japanese Society of Gastroenterological Surgery.