Case Report
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Sep 14, 2012; 18(34): 4794-4797
Published online Sep 14, 2012. doi: 10.3748/wjg.v18.i34.4794
Development of perianal ulcer as a result of acute fulminant amoebic colitis
Takayuki Torigoe, Yoshifumi Nakayama, Koji Yamaguchi
Takayuki Torigoe, Yoshifumi Nakayama, Koji Yamaguchi, Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan
Author contributions: Torigoe T and Nakayama Y performed surgery and clinical follow-up; Torigoe T wrote the manuscript; and Yamaguchi K revised the manuscript.
Correspondence to: Takayuki Torigoe, MD, PhD, Department of Surgery 1, School of Medicine, University of Occupational Environmental Health, 1-1 Iseigaoka, Yahata-nishi-ku, Kitakyushu 807-8555, Japan. cyotori@yahoo.co.jp
Telephone: +81-93-6031611 Fax: +81-93-6032361
Received: February 23, 2012
Revised: April 23, 2012
Accepted: April 27, 2012
Published online: September 14, 2012
Abstract

We report a case of acute fulminant amoebic colitis that resulted in the development of a perianal ulcer in a 29-year-old Japanese homosexual man with acquired immunodeficiency syndrome (AIDS). The patient was admitted to our hospital with a persistent perianal abscess that was refractory to antibiotic therapy administered at another hospital. On admission, we observed a giant ulcer in the perianal region. At first, cytomegalovirus colitis was suspected by blood investigations. Ganciclovir therapy was initiated; however, the patient developed necrosis of the skin around the anus during therapy. We only performed end-sigmoidostomy and necrotomy to avoid excessive surgical invasion. Histopathological examination of the surgical specimen revealed the presence of trophozoite amoebae, indicating a final diagnosis of acute fulminant amoebic colitis. The patient’s postoperative course was favorable, and proctectomy of the residual rectum was performed 11 mo later. Amoebic colitis is one of the most severe complications affecting patients with AIDS. Particularly, acute fulminant amoebic colitis may result in a poor prognosis; therefore, staged surgical therapy as a less invasive procedure should be considered as one of the treatment options for these patients.

Keywords: Acute fulminant amoebic colitis, Perianal ulcer, Acquired immunodeficiency syndrome, Cytomegalovirus colitis, Staged surgery