A 70-year-old man receiving thrice-weekly gemcitabine (1,500 mg) for liver metastasis following resection of biliary cancer underwent hepatectomy 3 years postoperatively for non-response to chemotherapy. Over the last three years, he had had unprotected intercourse with commercial sex workers for one month. Diarrhea and a fever developed on postoperative day 7; despite the administration of tazobactam/piperacillin, sepsis developed on postoperative day 10. A Clostridioides difficile toxin enzyme immunoassay and blood culture results were negative, and contrast-enhanced abdominal computed tomography revealed pancolonic wall thickening and edema (Picture 1). Before intensive-care unit transfer, diagnostic colonoscopy revealed pseudomembranous colitis (Picture 2). A colonic biopsy demonstrated numerous amoebic trophozoites with ingested erythrocytes in the mucous membrane ulcers (Picture 3). Pseudomembranous colitis is commonly caused by C. difficile, other pathogens (e.g., enterohemorrhagic Escherichia coli and Cytomegalovirus), and ischemic enteritis (1); however, an amoeba was responsible in this case.
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This paper was written after obtaining informed consent.
The authors state that they have no Conflict of Interest (COI).
References
- 1. Tang DM, Urrunaga NH, Von Rosenvinge EC. Pseudomembranous colitis: not always Clostridium difficile. Cleve Clin J Med 83: 361-366, 2016. [DOI] [PubMed] [Google Scholar]