Abstract
A 50-year-old Japanese man with a ten-year history of smoldering adult T-cell leukemia / lymphoma was admitted to a local hospital with ileus after two weeks of diarrhea. He developed shock, dyspnea, thrombocytopenia, and leukocytopenia four days later. He was immediately transferred to our hospital and underwent emergency laparotomy. Transmural necrosis of the cecum, ascending colon, transverse colon, and rectum was observed and total colectomy with ileostomy was performed. On the seventh day after operation, the report of histopathological analysis of the resected specimen indicated the presence of amebic trophozoites throughout the colonic wall and immediate microscopy of fresh stool confirmed amebiasis. In response to this, 500mg metronidazole was daily administered directly into the remaining rectum. Despite intensive therapy, the patient died of multiple organ failure on the ninth hospital day. Fulminant amebic colitis is defined as transmural and wide necrosis of the large bowel due to amebic invasion of the colonic wall. In our patient, computed tomography (CT) scan at the previous hospital had revealed significant wall thickening of the large bowel with intramural gas in the ascending colon. These CT findings may be useful for the diagnosis of transmural necrosis of the large bowel in amebiasis.
