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Ameboma: an unusual cause of gastrointestinal bleeding during severe leptospirosis
Tristan Legris1, Marie-Christine Jaffar-Bandjee, Olivier Favre
1Service de Néphrologie, Dialyse et Transplantation Rénale, Centre Hospitalier Universitaire Felix Guyon, Saint-Denis, La Réunion, France. tristan.legris@ap-hm.fr.
Background:
Severe leptospirosis occurs mainly in a tropical environment and includes icterus, acute renal failure and hemorrhages. These bleedings, which are mainly a consequence of acute homeostatic disturbances, can also reveal simultaneous diseases. Coinfections with other tropical diseases have been previously reported during leptospirosis. To our knowledge, invasive amebiasis, which can induce gastrointestinal bleedings, has never been described in the course of severe leptospirosis.
Case Presentation:
In this report, we describe a case of a 60 year-old man living in Reunion Island (Indian Ocean, France) admitted to our intensive care unit for severe Leptospira interrogans serovar icterohaemorrhagiae infection with neurological, renal, liver and hematological involvement. Two lower gastrointestinal bleedings occurred 7 and 15 days after admission. The first episode was promoted by hemostatic disturbances while the second bleeding occurred during low-dose heparin therapy. Colonoscopy revealed a pseudo-tumoral inflammatory mass of the recto-sigmoid junction. Histological examination found trophozoites inside mucinous exudate suggestive of Entamoeba histolytica. Amoebic serology was strongly positive whereas careful detection of cysts or trophozoites on saline-wet mount was negative in three consecutive samples of stools. Amoxicillin followed by metronidazole therapy, combined with supportive care, led to an improvement in the clinical and biological patient's condition and endoscopic appearances.
Conclusion:
Clinicians should be aware that gastrointestinal bleeding during severe leptospirosis could not solely be the consequences of hemostatic disturbances. Careful endoscopic evaluation that may reveal curable coinfections should also be considered.
Insights
Severe leptospirosis can present with gastrointestinal bleeding, which may indicate a co-infection with invasive amebiasis. Clinicians should consider endoscopic evaluation to identify and treat such coinfections alongside leptospirosis.
Area of Science:
- Infectious Diseases
- Tropical Medicine
- Gastroenterology
Background:
- Severe leptospirosis is a tropical disease characterized by jaundice, acute renal failure, and hemorrhages.
- Hemorrhages in leptospirosis are often linked to hemostatic disturbances but can also signal co-existing conditions.
- Invasive amebiasis, a cause of gastrointestinal bleeding, has not been previously documented in severe leptospirosis cases.
Observation:
- A 60-year-old man with severe Leptospira interrogans serovar icterohaemorrhagiae infection developed two episodes of lower gastrointestinal bleeding.
- Colonoscopy revealed a pseudo-tumoral inflammatory mass, and histological examination identified Entamoeba histolytica trophozoites.
- Amoebic serology was positive, though stool examinations for parasites were negative.
Findings:
- The patient experienced gastrointestinal bleeding episodes, one linked to hemostatic issues and another during heparin therapy.
- Histological findings confirmed invasive amebiasis coexisting with severe leptospirosis.
- Treatment with amoxicillin and metronidazole improved the patient's condition and endoscopic findings.
Implications:
- Gastrointestinal bleeding in severe leptospirosis warrants consideration beyond hemostatic disturbances.
- Endoscopic evaluation is crucial for identifying and treating potentially curable coinfections like invasive amebiasis.
- Awareness of this coinfection can improve patient outcomes in severe leptospirosis cases.
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