# A Case of Fulminant Amebiasis in a Female Commercial Sex Worker in Japan Requiring Subtotal Colectomy: A Literature Review and Case Report

## TL;DR

A woman in Japan with a rare severe amebiasis infection required emergency surgery and survived, highlighting the importance of early treatment.

## Contribution

Reports a rare case of fulminant amebiasis in a female commercial sex worker and analyzes survival benefits of early anti-amoebic treatment.

## Key findings

- Early administration of anti-amoebic agents significantly improves survival in fulminant amebiasis.
- Most patients are not diagnosed with amebiasis at admission, leading to delayed treatment.
- Surgical intervention is often required due to intestinal perforation or necrosis.

## Abstract

Fulminant amebiasis is a rare, potentially lethal condition caused by Entamoeba histolytica. It causes intestinal perforation and generalized peritonitis, and treatment requires an emergency operation and the administration of anti-amoebic drugs. Although E. histolytica infections are more commonly reported in men who have sex with men, we report a successfully treated case of fulminant amebiasis in a female commercial sex worker (CSW). This report presents a review of previously reported cases.

A 41-year-old woman with a 4-year history as a CSW presented to the emergency department with abdominal pain and diarrhea. She was admitted with acute colitis of unknown etiology. Stool tests performed after admission revealed E. histolytica, confirming the diagnosis of amoebic colitis, and treatment with metronidazole was initiated. On day 8 of treatment, the patient’s respiratory status worsened. Abdominal CT revealed a perforation of the transverse colon, leading to the diagnosis of fulminant amebiasis. Emergency laparotomy including subtotal colectomy and ileostomy was performed. Postoperatively, the patient’s condition gradually improved without complications, and she was discharged on POD 97 after finding housing. We reviewed and analyzed 52 reported cases of fulminant amebiasis, including the present case, treated with bowel resection in Japan since 2000. According to our literature review, the mortality rate was 28.8% and only 9.6% of patients were diagnosed with amebiasis at the time of hospital admission. Gastrointestinal perforation or necrosis requiring surgical intervention occurred after admission in 72.9% of patients. The mortality rate was 23.0% in patients who received anti-amoebic agents preoperatively compared to 30.7% in those who did not. Notably, the mortality rate reached 100% for patients where anti-amoebic agents were not administered, suggesting that such treatment is essential for survival (p = 0.005).

Here, we present a successfully treated case of fulminant amebiasis in a female CSW. Analysis of previously reported cases suggests that the early administration of anti-amoebic agents is important for survival.