From erythema nodosum to amoebiasis - A case learned from international medicine clinic
Journal
Journal of Internal Medicine of Taiwan
Journal Volume
26
Journal Issue
6
Pages
313-318
Date Issued
2015
Author(s)
Abstract
A 58-year-oW German working in Taiwan presented to this hospital with the complaint of painful erythematous nodules and plaques for more than 2 weeks. Steroid and non-steroidal anti-inflammatory drugs had been given at a regional hospital with transient partial response followed by rebound of local symptoms and progression of leukocytosis. He has been stayed for 4 months in Jakarta, Indonesia. He denied history of previous pharyngitis or sulfonamide exposure. Erythema nodosum was diagnosed and a diagnostic process for potential etiologies was began. An abnormal alkaline phosphatase and y-glutamyl transpeptidase lead to an abdominal computed tomography, which disclosed edematous transverse colon with increased mucosal contrast enhancement. At the same time the patient reported new fresh-blood-tinged stool passage. A colonoscopy revealed multiple ulcers at ascending colon. Serum indirect hemagglutination tost for amoeba was positive (titer 1:256). Biopsy of the colon revealed amoebic trophozoite with erythrocyte phagocytosis. Stool PCR for Entamoeba histolytica was positive at CDC laboratory. Amoebic colitis in a HIV-negative healthy adult was (iagnosed. Erythema nodosum is a rare presenting symptom for amoebiasis. There were only two cases reported In the literature. Considering erythema nodosum is an immune-mediated presention, diagnostic approach for underlying etiology is paramount important particularly when steroid therapy is considered.
Other Subjects
alkaline phosphatase; contrast medium; gamma glutamyltransferase; nonsteroid antiinflammatory agent; steroid; sulfonamide; abdomen; adult; alkaline phosphatase blood level; amebiasis; amoeba (life cycle stage); Article; ascending colon; case report; colon ulcer; colonoscopy; computer assisted tomography; contrast enhancement; diagnostic test; Entamoeba histolytica; erythema; erythema nodosum; feces analysis; gamma glutamyl transferase blood level; hemagglutination test; human; Indonesia; laboratory; leukocytosis; male; middle aged; phagocytosis; pharyngitis; polymerase chain reaction; rebound; skin nodule; steroid therapy; symptom; transverse colon
Publisher
Society of Internal Medicine of Taiwan
Type
journal article