Intestinal amoebiasis in a patient with acute graft‐versus‐host disease after allogeneic bone marrow transplantation successfully treated by metronidazole

Abstract

Amoebiasis has rarely been reported in patients undergoing hematopoietic stem cell transplantation, although it is a world-wide infection and extremely common. We present a case of intestinal amoebiasis unexpectedly revealed by colonoscopy after allogeneic bone marrow transplantation from a human leukocyte antigen-mismatched unrelated donor for acute myeloid leukemia arising from chronic myelomonocytic leukemia and successfully treated by metronidazole.

Fulminant Amebic Colitis after Corticosteroid Therapy: A Systematic Review

“…In all, 14 of 24 (58%) cases were given corticosteroid medications for initially misdiagnosed colitis ( Table 1 ), including misdiagnosed inflammatory bowel disease (11 of 24 cases, 46%) [ 18 – 20 , 22 , 26 , 28 – 30 , 33 , 37 ], intestinal vasculitis (2 of 24 cases, 8%) [ 23 , 25 ], and abdominal tuberculosis (1 of 24 cases, 4%) [ 24 ]. The remainder were given corticosteroid medications for the indication of prevention or treatment of graft-versus-host disease (GVHD) following transplantation (5 of 24, 21%) [ 16 , 31 , 34 , 36 ], respiratory illness (3 of 24 cases, 12.5%) [ 21 , 32 , 35 ], multiple myeloma (1 of 24, 4%) [ 17 ] and thrombocytopenic purpura (1 of 24, 4%) [ 27 ].…”

“…Co-morbidities in this series were high ( Table 1 ) and included 4 cases (17%) with underlying autoimmune disease [ 23 , 25 , 27 , 29 ]; 3 cases (12.5%) who underwent either stem cell or solid organ transplantation [ 16 , 31 , 34 ] and 2 cases (8%) with Human Immunodeficiency virus (HIV) co-infection [ 20 , 21 ]. Histologic evidence of cytomegalovirus (CMV) colitis was present in both of the cases with HIV, as well as a third case without additional immunocompromising state reported [ 20 , 21 , 25 ].…”

“…Fourteen cases (58%) were treated with other immune modulating therapies in addition to corticosteroids. These included the anti-inflammatory agents sulfasalazine and mesalamine (8 of 24, 33%) [ 15 , 18 – 20 , 22 , 28 , 33 , 37 ], antimetabolites azathioprine or mercaptopurine (2 of 24, 8%) [ 34 , 37 ], methotrexate (3 of 24, 12.5%) [ 16 , 29 , 31 ], tacrolimus (2 of 22, 8%) [ 16 , 34 ], cyclosporine (3 of 24, 12.5%) [ 31 , 36 ], anti-thymocyte antiglobulin (1 of 24, 4%) [ 16 ] and hydroxychloroquine (1 of 24, 4%) [ 25 ]. The case with thrombocytopenic purpura underwent plasmapheresis while also receiving corticosteroids and prior to aggravation of symptoms.…”

“…Most cases (13 of 24, 54%) had involvement of multiple areas of bowel, including pancolitis in seven cases (29%) [ 18 , 20 , 22 , 23 , 25 , 26 , 33 ]. Proctosigmoid involvement was documented in four cases (17%) [ 15 , 16 , 28 , 31 ], descending colon in two cases (8%)[ 16 , 28 ], transverse colon in five cases (21%)[ 16 , 28 , 29 , 31 , 34 ], ascending colon in five cases (21%) [ 29 – 32 , 34 ], cecal/ ileo-cecal in five cases (21%) [ 21 , 24 , 27 , 30 , 31 ], jejenal in one case (4%) [ 35 ] and exact location of colitis not specified in two cases (8%) [ 17 , 19 ].…”

“…Of those with positive serology, 7 of 10 cases (70%) had at least one other positive study. The 5 cases with negative serology included both cases who underwent stem cell transplantation [ 16 , 31 ], a case with AIDS [ 21 ], a case with Lupus [ 23 ] and a case with Crohn disease [ 37 ]. The type of serologic assay performed was not consistently reported.…”