Multicentric ameboma of the colon mimicking Crohn℉s disease

Abstract

Entamoeba histolytica infection can lead to colitis, colonic perforation abscess, and ameboma formation. Amebic colitis is common in developing countries, with its varied and nonspecific symptoms. Amebomas can occur rarely due to the formation of excess granulation tissue which usually occurs in cecum and ascending colon. A 64-year-old lady presented with abdominal pain and mass in the right side of abdomen. Imaging showed multicentric colonic masses. On colonoscopy multiple stricturizing ulcerated lesions involving cecum, ascending, proximal transverse colon, and splenic flexure were seen, which were suggestive of Crohn′s disease or multicentric neoplasm. Histopathological examination revealed multicentric lesion with focal necrosis and trophozoites of E. histolytica. Diagnosis of ameboma was made and antiamoebic treatment was started. She had full resolution of symptoms. We present this case since it is a case of ameboma, a rare complication of amebic colitis with an extremely rare presentation of multiple ulcerated stricturizing lesions, involving cecum, ascending, transverse colon, and splenic flexure which typically resembled Crohn′s disease.

Key words

Amebic colitis - Crohn′s disease - multicentric ameboma

• References

• 1 Stanley SL Jr. Amoebiasis. Lancet 2003;361:1025-34.
• 2 Peláez M, Villazón A, Sieres Zaraboso R. Amebic perforation of the colon. Dis Colon Rectum 1966;9:356-62.
• 3 Li E, Stanley SL Jr. Protozoa. Amebiasis. Gastroenterol Clin North Am 1996;25:471-92.
• 4 Hardin RE, Ferzli GS, Zenilman ME, Gadangi PK, Bowne WB. Invasive amebiasis and ameboma formation presenting as a rectal mass: An uncommon case of malignant masquerade at a western medical center. World J Gastroenterol 2007;13:5659-61.
• 5 Misra SP, Misra V, Dwivedi M. Ileocecal masses in patients with amebic liver abscess: Etiology and management. World J Gastroenterol 2006;12:1933-6.
• 6 Fernandes H, D′Souza CR, Swethadri GK, Naik CN. Ameboma of the colon with amebic liver abscess mimicking metastatic colon cancer. Indian J Pathol Microbiol 2009;52:228-30.
• 7 Takahashi T, Gamboa-Dominguez A, Gomez-Mendez TJ, Remes JM, Rembis V, Martinez-Gonzalez D, et al. Fulminant amebic colitis: Analysis of 55 cases. Dis Colon Rectum 1997;40:1362-7.
• 8 Rashidul Haque, Christopher D.Huston, Molly Hughes, Eric Houpt, William A.Petri. Amoebiasis current concepts. N Engl J Med 2003;348:1565-73.
• 9 Bredin C, Margery J, Bordier L, Mayaudon H, Dupuy O, Vergeau B, et al. Diabetes and Amoebiasis: A high risk encounter. Diabetes Metab 2004;30:99-102.
• 10 Majeed SK, Ghazanfar A, Ashraf J. Caecal amoeboma simulating malignant neoplasia, ileocaecal tuberculosis and Crohn′s disease. J Coll Physicians Surg Pak 2003;13:116-7.
• 11 Fenoglio-Preiser CM, Noffinsinger AE, Stemmerman GN, Lantz PE, Listrom MB, Rilke FO. Non neoplastic lesions of the colon. In: Gastrointestinal Pathology: An Atlas and Text. 2 nd ed. Philadelphia: Lippincott-Raven; 1999.
• 12 Ray G, Iqbal N. Right colonic mass with hepatic lesion - Remember ameboma? Indian J Gastroenterol 2006;25:272.
• 13 Sharma D, Patel LK, Vaidya VV . Amoeboma of ascending colon with multiple liver abscesses. J Assoc Physicians India 2001;49:579-80.