SHM Converge Scientific Abstract ePoster Gallery-The Hidden Parasite: An Ibd Mimicker Unveiled

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This case describes a 56-year-old man initially treated as having steroid-refractory inflammatory bowel disease (IBD), but later found to have amebic colitis due to Entamoeba histolytica.<br /><br />He presented with 9 days of abdominal pain, malaise, and loose bloody stools, with repeated emergency and outpatient visits. Workup showed leukocytosis and elevated CRP, but common infectious and inflammatory tests were negative. CT imaging demonstrated colonic wall thickening, and colonoscopy showed severe inflammation with erosions, friability, and deep ulcerations. Biopsies at the outside hospital showed chronic colitis without visible organisms, granulomas, or viral changes, leading to treatment as presumed IBD with IV steroids and discharge on prednisone. He was readmitted two weeks later, restarted on IV steroids, and later received infliximab. Despite a fall in CRP from 183 to 16.5, symptoms persisted and worsened after biologic therapy, with significant weight loss.<br /><br />On repeat colonoscopy at Yale, large ulcerations and friable mucosa involving about 75% of the surface were seen. Pathology then revealed intraluminal amoebae throughout the tissue, and serology identified Entamoeba histolytica, confirming amebic colitis. He was initially started on metronidazole and then switched to paromomycin on discharge.<br /><br />The key lesson is that Entamoeba histolytica can closely mimic IBD, even without travel to an endemic area. Patients labeled as steroid-refractory IBD who fail to improve as expected should be evaluated for atypical infections before escalating immunosuppression, since steroids and biologics can worsen amoebiasis and lead to severe, potentially fatal disease.

Asset Subtitle

Anisha Advani

Meta Tag

Author List Anisha Advani, Kevin Titus, Luke Debenham

Category Clinical Vignettes

Concept Entamoeba histolytica

Concept Inflammatory Bowel Disease

Concept Colitis

Concept Corticosteroids

Concept Stool Ova and Parasite Test

Distinguished Non-Finalist

Presenter Organization Yale New Haven Health

Presenting Author Anisha Advani

Track Adult

Keywords

amebic colitis

Entamoeba histolytica

inflammatory bowel disease

steroid-refractory colitis

bloody diarrhea

colonic ulcerations

infliximab

metronidazole

paromomycin

immunosuppression

Entamoeba histolytica

Inflammatory Bowel Disease

Colitis

Corticosteroids

Stool Ova and Parasite Test