A Case of Peristomal Cutaneous Ulcer Following Amebic Colitis Caused by <i>Entamoeba hstolytica </i>

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  • SASAKI Yu
    Department of Dermatology, National Hospital Organization Tokyo Medical Center
  • YOSHIDA Tetsuya
    Department of Dermatology, National Hospital Organization Tokyo Medical Center
  • SUZUKI Jun
    Division of Clinical Microbiology, Department of Microbiology, Tokyo Metropolitan Institute of Public Health
  • KOBAYASHI Seiki
    Department of Infectious Diseases, Keio University School of Medicine
  • SATO Tomotaka
    Department of Infectious Diseases, Keio University School of Medicine,<sup>4) </sup>Department of Dermatology, Kitasato University Kitasato Institute Hospital

Bibliographic Information

Other Title
  • <i>Entamoeba histolytica </i>による大腸炎から人工肛門周囲に皮膚潰瘍を併発した1 例
  • 症例 Entamoeba histolyticaによる大腸炎から人工肛門周囲に皮膚潰瘍を併発した1例
  • ショウレイ Entamoeba histolytica ニ ヨル ダイチョウエン カラ ジンコウコウモン シュウイ ニ ヒフ カイヨウ オ ヘイハツ シタ 1レイ

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Abstract

A 66-year-old Japanese male with a history of a rectal ulcer and rectovesical fistula following brachytherapy and radiotherapy for prostate cancer, who had undergone colostomy and vesicotomy presented with a painful peristomal ulcer of approximately 5×2.5cm adjacent to the direction of 6 oʼclock of the stoma in his left lower abdomen. Although he was admitted to be treated with intravenous antibiotics and topical debridement, the ulcer was rapidly increasing. In the laboratory findings, WBC was 12,400/μL, CRP was 16.9 mg/dL, ESR was 105mm in the first hour. Contrast enhanced CT images showed a wide high density area of skin and subcutaneous tissue around the stoma and dillitation of the transverse and descending colon. Colonoscopy showed furred profound ulcers in the rectum. A biopsy from the ulcer floor submitted to histopathology showed necrotic tissue with a mixed inflammatory infiltrates mainly composed of neutrophils and lymphocytes in the dermis. We suspected pyoderma gangrenosum with an inflammatory bowel disease in the beginning. Although he was started on oral prednisolone 60mg daily, the ulcer did not respond to treatment. Additional methylprednisolone pulse therapy, intravenous cyclosporine and granulocytapheresis were also ineffective. A biopsy specimen from the skin ulcer margin showed erythrophagocytosis by trophozoites of amebae which were identified on PAS stained slides. The PCR method and stool examination showed positive for Entamoeba histolytica (E. histolytica), but serum antibodies were negative. Within two weeks of treatment with oral metronidazole 2,250mg/day and topical metronidazole ointment, resolution of the ulcer was observed, then the prednisolone dosage was tapered. A split-thickness skin graft was used to cover the ulcer with a successful result. Even though we originally misdiagnosed this case, we finally reached a diagnosis of amebiasis. It is important to take account of amebiasis in the differential diagnosis of intractable ulcers which can be contaminated by feces.

Journal

  • Kansenshogaku Zasshi

    Kansenshogaku Zasshi 90 (1), 73-76, 2016

    The Japanese Association for Infectious Diseases

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