Intestinal amoebiasis and pediatric inflammatory bowel disease in an endemic region: Three case reports

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.

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.

Amoebiasis screening in endemic regions is helpful in flare of UC to avoid misdiagnosis and inappropriate escalation of immunosuppressive therapy.