Kumari N, Srivastava A, Sarma MS, Poddar U. Intestinal amoebiasis and pediatric inflammatory bowel disease in an endemic region: Three case reports. World J Clin Pediatr 2026; 15(4): 121468 [DOI: 10.5409/wjcp.121468]
Corresponding Author of This Article
Anshu Srivastava, MD, Professor, Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareily Road, Lucknow 226014, Uttar Pradesh, India. avanianshu@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
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case-report
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Kumari N, Srivastava A, Sarma MS, Poddar U. Intestinal amoebiasis and pediatric inflammatory bowel disease in an endemic region: Three case reports. World J Clin Pediatr 2026; 15(4): 121468 [DOI: 10.5409/wjcp.121468]
World J Clin Pediatr. Dec 9, 2026; 15(4): 121468 Published online Dec 9, 2026. doi: 10.5409/wjcp.121468
Intestinal amoebiasis and pediatric inflammatory bowel disease in an endemic region: Three case reports
Nitu Kumari, Anshu Srivastava, Moinak Sen Sarma, Ujjal Poddar
Nitu Kumari, Anshu Srivastava, Moinak Sen Sarma, Ujjal Poddar, Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
Co-first authors: Nitu Kumari and Anshu Srivastava.
Author contributions: Kumari N contributed to study conception and primary drafting of the manuscript; Srivastava A contributed to study conception, co-drafting and critical revision of the manuscript; Sarma MS, Poddar U contributed to intellectual inputs and critical revision of the manuscript; Kumari N and Srivastava A have made crucial and indispensable contributions towards the completion of the project and thus qualified as the co-first authors of the paper.
AI contribution statement: The authors take full responsibility and accountability for all content of this manuscript. No artificial intelligence tools were used in the preparation, analysis or writing of this manuscript.
Informed consent statement: Informed written informed consent was obtained from the parents or legal guardians of all patients for publication of this case series and any accompanying clinical information.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Anshu Srivastava, MD, Professor, Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareily Road, Lucknow 226014, Uttar Pradesh, India. avanianshu@gmail.com
Received: March 27, 2026 Revised: May 18, 2026 Accepted: June 10, 2026 Published online: December 9, 2026 Processing time: 178 Days and 12.9 Hours
Abstract
BACKGROUND
Differentiating superadded amoebic colitis (AC) from a disease flare in children with ulcerative colitis (UC) is challenging, particularly in endemic regions, yet remains crucial for guiding appropriate therapy and preventing adverse outcomes.
CASE SUMMARY
We report three children with UC and intestinal amoebiasis; two presenting as disease exacerbation and one with first presentation as acute severe colitis (ASC), highlighting key diagnostic and therapeutic dilemmas. Two children with UC, previously in clinical remission on maintenance therapy, presented with abdominal pain and bloody diarrhea; one had fever of short duration. A provisional diagnosis of disease flare was made in both. The third case presented for the first time as ASC, was treated outside with corticosteroids and referred due to non-response. Stool microscopy identified amoebic trophozoites with haemophagocytosis, consistent with Entamoeba histolytica in all. Initial anti-amoebic therapy with metronidazole resulted in transient clinical improvement; however, each patient subsequently required escalation of immunosuppression for symptom control. Our cases suggest the co-existence of AC over active UC at the same time.
CONCLUSION
Amoebiasis screening in endemic regions is helpful in flare of UC to avoid misdiagnosis and inappropriate escalation of immunosuppressive therapy.
Core Tip: Amoebic colitis (AC) can closely mimic ulcerative colitis (UC) activity, particularly in regions where amoebiasis is endemic. Failure to recognize this infection may lead to inappropriate escalation of immunosuppressive therapy and worsening disease. Through this case series of three children with UC, presenting with concomitant AC, we highlight the diagnostic challenges and emphasize the importance of evaluation for infectious etiologies in inflammatory bowel disease flare before intensifying immunosuppressive treatment.
