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Case Studies | Medicine Science | India | Volume 14 Issue 2, February 2025 | Popularity: 5.4 / 10
A Rare Case of Amebic Proctitis: Diagnostic Challenges and Clinical Insights
Dr. Manjunath B V, Dr Pugazhendhi
Abstract: Methods: A 58years female who presented with complaints of altered bowel habits with occasional blood in stools for 1 month duration, patient didn?t have history of fever, abdominal pain, tenesmus, weight loss or loss of appetite, no other constitutional symptoms. Patients was a known case of diabetes and hypertension. Clinical examination was unremarkable, digital rectal examination was normal. All the routine investigations were done were normal. Stool calprotectin was borderline elevated 54 iu/l, CECT abdomen showed symmetrical rectum thickening with peri rectal fat stranding. Patient was subjected for colonoscopy which showed features suggestive of solitary rectal ulcer syndrome and biopsy was taken which revealed nonspecific colitis. Patient was started with SR fill enema and dietary advice, patient responded to treatment initially and symptoms reappeared in the form of 3 - 4 loose stools with drops of blood in stools. Due to worsening symptoms and serial elevated calprotectin patient was started on mesalofoam enema along with oral mesalamine. Despite being treated with mesalamine patients were reoccurring, which led to clinical dilemma. Patient was subjected to repeat sigmoidoscopy and NBI targeted multiple biopsies were taken from rectosigmoid junction. Repeat biopsy HPE was confirmatory of amebic colitis and hence patient was started with oral metronidazole. Patient responded very well and became completely asymptomatic. Result: High clinical suspicion for amebic colitis even though the rectal involvement was quite uncommon and Repeat sigmoidoscopy with multiple targeted biopsies with histopathology examination proved amebic colitis. Patient had clinical response from day2 of initiating metronidazole. Conclusion: Rectal involvement in amebic colitis is rare. One should consider the possibility of amoebiasis in patient of left side colitis (proctitis) not responding to oral or rectal immunosuppressant rather than escalating the immunosuppressants for the patients from tropical countries.
Keywords: Amebic colitis, rectal involvement, sigmoidoscopy, metronidazole treatment, SRUS, solitary rectal ulcer syndrome
Edition: Volume 14 Issue 2, February 2025
Pages: 1599 - 1601
DOI: https://www.doi.org/10.21275/SR25226165213
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