A114 AMEBIC COLITIS AS A RARE CAUSE OF PSEUDOMEMBRANOUS COLITIS

Abstract Background Globally, Entamoeba histolytica results in nearly 40 million cases of amebic colitis and 50 000 deaths annually. The disease is common in Africa, Asia, and Central and South America but infection remains rare in North America, limited to travelers, immigrants, and immunocompromised hosts. The disease ranges from asymptomatic chronic colonization to dysentery and fulminant colitis. Endoscopically, the ulcerations may demonstrate the non-specific pattern of pseudomembranous colitis that is classically seen with Clostridoides difficile infection. Aims To discuss an unusual case of pseudomembranous colitis caused by Entamoeba histolytica. Methods The patient records were reviewed and a review of the literature was performed. Results A 54-year-old male with a remote history of peptic ulcer disease visiting from Guinea presented with a 3-day history of right sided abdominal cramping and intermittent bloody diarrhea. The pain was gradual in onset with moderate severity. He reported >5 episodes of blood intermixed with brown stools. He was incidentally diagnosed with hypertension and started on treatment two weeks prior. He denied recent antibiotic use and family history was unremarkable for inflammatory bowel disease (IBD) or other forms of colitis. There was no abdominal tenderness or bleeding on rectal examination. He had a stable normocytic anemia (Hgb 114), leukocytosis (13.4) with neutrophilia, and elevated C-reactive protein (43.4 mg/L). He was discharged with presumed resolving ischemic colitis. Colonoscopy showed diffuse colonic involvement with areas of patchy yellow plaques and a mix of shallow and deep non-bleeding ulcers suggestive of pseudomembranous colitis. He was discharged with empiric oral vancomycin, later discontinued following negative C. difficile toxin testing. Stool cultures and microscopy detected Entamoeba histolytica. Limited biopsies of the nodular ulcers failed to show any pathologic alterations or trophozoites. The patient was treated for luminal amebiasis with oral metronidazole and paromomycin but was lost to follow up on return to his native country. Conclusions Amebic colitis remains a rare entity in the developed world and is limited to travelers or recent immigrants from endemic areas. Diagnosis is typically difficult and may require endoscopy as its clinical course may resemble IBD or infectious colitis. Limited cases exist of fulminant amebic colitis causing pseudomembranous colitis, with even fewer cases of mild dysentery having this appearance. Despite pseudomembranous colitis being commonly associated with C. difficile infection, this pattern of mucosal injury may be seen with other enteric bacterial and protozoan infections, inflammatory conditions, or use of certain medications. In the appropriate clinical context, on exclusion of C. difficile, secondary causes such as active amebiasis should be considered. Funding Agencies None

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