Challenging diagnosis of amebiasis in a non-endemic region: a clinical case

Abstract

In Russia, amebiasis is sporadically registered mainly in the southern regions. An endemic area is the Republic of Dagestan. We describe a clinical case, which illustrates challenges in the diagnosis of amebial colitis related to low awareness of physicians of parasitic diseases in non-endemic regions. A 38-year old female patient living in Moscow was initially misdiagnosed with Crohn's disease. Erosive and ulcerative colonic lesions found at colonoscopy were interpreted by a gastroenterologist as symptoms of an inflammatory bowel disease. No differential diagnosis with infections and parasitic diseases was performed. Long (2 years) persistence of symptoms despite treatment with 5-aminosalicylic agents for suspected Crohn's disease, absence of any significant laboratory abnormalities and no history of travelling to Asian countries were the reason for subsequent additional diagnostic work-up. After the patient was finally diagnosed with intestinal amebiasis, she was treated with metronidazole with some positive effect of decreased abdominal bloating and bowel growling. At the control colonoscopy, there was a positive trend seen in colonic mucosa, with healing of ulcers without any scarring. No protozoan cysts were any more found in her feces. According to the recommendations, the patient is regularly seen by a specialist in infectious diseases and a gastroenterologist. Expansion of amebiasis outside endemic regions points to the necessity to perform a wider diagnostic work-up in cases of mucosal lesions found at colonoscopy.

Keywords

• amebiasis
• crohn's disease
• ulcerative colitis
• appendicitis
• endoscopy