A Case of Fulminant Amoebic Colitis Associated with HIV Infection

• Published in: Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine) Vol. 26; no. 1; pp. 91 - 95
• Main Authors: Arai, Takekazu, Mimura, Toshiki, Adachi, Miki, Oomi, Takuma, Yamada, Hideki, Haku, Kyokun, Nozawa, Keijiro, Matsuda, Keiji, Kodaira, Susumu, Okinaga, Kota
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society for Abdominal Emergency Medicine 2006
• ISSN: 1340-2242; 1882-4781
• DOI: 10.11231/jaem1993.26.91

A 49-year-old man presented with abdominal pain and diarrhea in August, 2003. Twelve days later, he developed rectal bleeding and a high fever and was admitted to a local hospital with a diagnosis of intestinal obstruction. He was transferred to our department after showing no improvement for 19 days since the onset of his symptoms. During an anal digital examination performed at admission, a large amount of liquid stool mixed with necrotic tissue and pus was discharged. A colonoscopy revealed extensive mucosal necrosis from the rectum to the sigmoid colon. An emergency operation was performed under a diagnosis of generalized peritonitis caused by necrosis of the rectosigmoid. During a laparotomy, purulent ascites with an offensive odor weve noted, and the cecum as well as the rectosigmoid seemed to be necrotic. The necrotic portion of the colon, descending through the sigmoid colon and the rectum, were resected, and a descending colostomy was constructed. An ileocecal resection was also performed, and a duble-barreled ileostomy and ascending colostomy were constructed. Because the wet blotting paper-like appearance of the resected specimen strongly suggested amebiasis, metronidazole was administered through a nasogastric tube immediately after the surgery. Although a stool culture did not demonstrate trophozoites, amebiasis was confirmed by histological examination of the resected specimen. Postoperatively, he was diagnosed as having an HIV infection with positive HIV-1 antibody and positive HIV-1 using a Western blotting method. Although he recovered temporarily after the surgery, his condition was complicated by disseminated intravascular coagulopathy, hepatic failure and renal failure, and he died on the 51st postoperative day.