Fulminant necrotizing amoebic colitis presenting as acute appendicitis: a case report and comprehensive literature review

  • Nur Rahadiani Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia / Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Muhammad Habiburrahman Faculty of Medicine, Universitas Indonesia / Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia https://orcid.org/0000-0001-6372-8240
  • Agi Satria Putranto Division of Digestive Surgery, Department of Surgery, Faculty of Medicine, Universitas Indonesia / Dr. Cipto Mangunkusumo National Hospital, Jakarta, Indonesia https://orcid.org/0000-0001-9667-3346
  • Diah Rini Handjari Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia / Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia https://orcid.org/0000-0001-9377-0984
  • Marini Stephanie Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia / Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia https://orcid.org/0000-0002-5743-688X
  • Ening Krisnuhoni Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia / Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia https://orcid.org/0000-0002-3560-5590
Keywords: amoebiasis, intestinal, necrosis, metronidazole, Indonesia

Abstract

Intestinal amoebiasis is a parasitic infection caused by Entamoeba histolytica. It is commonly found in developing countries with poor hygiene. A rare, life-threatening complication of amoebiasis is fulminant necrotizing amoebic colitis (FulNAC). We report a 59-year-old male with acute lower right abdominal pain. Before coming to our institution, he was diagnosed with acute appendicitis. Extensive necrosis near the caecum involving the appendix and colon was observed intraoperatively. The patient underwent a right hemicolectomy, followed by an ileostomy and colostomy. Histopathologic examination confirmed the diagnosis of FulNAC. After the surgery, the patient was transferred to the high care unit and treated with metronidazole after histopathologic findings confirmed the etiology. The patient showed excellent response to the antibiotic prescribed, and the symptoms subsided. He was discharged from the hospital on day nine. Additionally, we reviewed fifty-one existing case reports on invasive intestinal amoebiasis worldwide, confirmed by histopathological examination following their preoperative diagnosis, surgery, pharmacology treatment, and outcomes. The learning point of this case is that intestinal amoebiasis should be considered a differential diagnosis for patients around fifty years old with bowel symptoms and travel history or living in tight quarters. Blood tests, radiological examinations, and serological evaluations are valuable diagnostic modalities. Metronidazole should be given as early as possible, and health promotion is recommended to prevent this disease in the population.

Published
2022-04-30
How to Cite
1.
Rahadiani N, Habiburrahman M, Putranto AS, Handjari DR, Stephanie M, Krisnuhoni E (2022) Fulminant necrotizing amoebic colitis presenting as acute appendicitis: a case report and comprehensive literature review. J Infect Dev Ctries 16:717-725. doi: 10.3855/jidc.15419
Section
Case Reports