Successful treatment with metronidazole and paromomycin for fulminant amoebic colitis during cytotoxic chemotherapy in a patient with small-cell lung cancer
Aya Kitaoka,
Kazuya Tanimura,
Yuto Yasuda,
Kensuke Nishioka,
Yutaka Hirayama,
Kiyoshi Uemasu,
Daisuke Iwashima,
Sou Arita,
Toshiyuki Kitai,
Susumu Hoshi,
Emi Date,
Norishige Iizuka,
Ken-ichi Takahashi
Affiliations
Aya Kitaoka
Department of Respiratory Medicine, Kishiwada City Hospital, Kishiwada, Japan
Kazuya Tanimura
Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Yuto Yasuda
Department of Respiratory Medicine, Kishiwada City Hospital, Kishiwada, Japan; Correspondence to: 1001 Gakuhara-cho, Kishiwada-shi, Osaka 586-8501, Japan.
Kensuke Nishioka
Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Yutaka Hirayama
Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Kiyoshi Uemasu
Department of Respiratory Medicine, Kishiwada City Hospital, Kishiwada, Japan
Daisuke Iwashima
Department of Respiratory Medicine, Kishiwada City Hospital, Kishiwada, Japan
Sou Arita
Medical economics division, Health insurance bureau, Ministry of Health, Labour and Welfare, Japan
Toshiyuki Kitai
Department of Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, Japan
Susumu Hoshi
Department of Gastroenterology, Kishiwada City Hospital, Kishiwada, Japan
Emi Date
Department of Pathology, Kishiwada City Hospital, Kishiwada, Japan
Norishige Iizuka
Department of Pathology, Kishiwada City Hospital, Kishiwada, Japan
Ken-ichi Takahashi
Department of Respiratory Medicine, Kishiwada City Hospital, Kishiwada, Japan
We report the case of a 64-year-old man with advanced small-cell lung cancer who developed fulminant amoebic colitis during cytotoxic chemotherapy. During the first cycle of carboplatin/etoposide treatment, febrile neutropenia and grade 4 neutropenia developed. Because diarrhea, abdominal pain, and bloody stool were observed, abdominal computed tomography was performed, showing intussusception, and extensive colectomy and colostomy were performed. Histopathology of the colon revealed gastrointestinal necrosis and perforation due to Entamoeba histolytica infection. Amoebiasis improved after treatment with metronidazole and paromomycin. The second cycle of carboplatin/etoposide with dose reduction was completed, resulting in a partial response to small-cell lung cancer.The results of this case suggest that paromomycin is an additional option for amoebiasis during cytotoxic chemotherapy, and persistent diarrhea during cytotoxic chemotherapy should alert clinicians to consider the development of amoebiasis.
