Fulminant Amoebic Colitis Associated with HIV Infection; Report of A Case

Satoshi Ishiyama, Koji Tsuruta, Satoshi Takeichi, Keiichi Takahashi, Masae Mori*, Akifumi Imamura*, Akihiko Suganuma*, Atsushi Ajisawa* and Masayoshi Negishi*

Department of Surgery and Department of Infectious Diseases*, Tokyo Metropolitan Komagome Hospital

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 the 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.

Key words
amoebic colitis, HIV, perforation

Reprint requests
Satoshi Ishiyama Department of Surgery, The Jikei University School of Medicine
3-25-8 Nishi-Shinbashi, Minato-ku, 105-8461 JAPAN

Accepted
June 27, 2007

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