Fulminant amebic colitis complicated by appendiceal perforation and massive abdominal hemorrhage: a case report and literature review

TL;DR

A rare case of severe amebic colitis with appendiceal perforation and abdominal bleeding is reported, highlighting the importance of early diagnosis and treatment.

Contribution

Demonstrates the utility of metagenomic sequencing in diagnosing fulminant amebic colitis in non-endemic regions.

Findings

Fulminant amebic colitis with appendiceal perforation and massive hemorrhage is rare but deadly.

Metagenomic sequencing can aid diagnosis when conventional methods are inconclusive.

Timely anti-amebic therapy is critical for improving outcomes in severe cases.

Abstract

Fulminant amebic colitis complicated by intestinal perforation or massive intra-abdominal hemorrhage is uncommon but associated with extremely high mortality. In non-endemic regions, diagnosis is frequently delayed because early manifestations resemble bacterial appendicitis or perforated peritonitis.

We report a fatal case of Entamoeba histolytica infection presenting with appendiceal perforation, septic shock, and recurrent intra-abdominal bleeding. Surgery revealed extensive transmural necrosis, deep ulcers, and exposure of submucosal vessels. Metagenomic next-generation sequencing (mNGS) of blood and peritoneal drainage fluid was performed, followed by histopathological confirmation. Despite emergent appendectomy, bowel resection, and prompt initiation of anti-amebic therapy, the patient developed refractory septic shock and recurrent intra-abdominal hemorrhage, resulting in death.

mNGS can facilitate early recognition of severe amebiasis when conventional diagnostic modalities are uncertain, particularly in non-endemic settings. Fulminant amebic colitis complicated by perforation or hemorrhage carries a poor prognosis. Timely clinical suspicion and early anti-amebic therapy are essential to improve outcomes.

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