背景:阿米巴结肠炎最近在中国不太普遍,并且其症状与炎症性肠病(IBD)的症状相似,导致难以早期识别和诊断。
方法:一名31岁男性出现间歇性腹泻和便血,最初高度怀疑为IBD。尽管服用美沙拉嗪后症状部分缓解,内镜溃疡基本保持不变.
方法:美沙拉嗪治疗开始两年后,在粪便显微镜下检测到阿米巴囊肿,在盲肠溃疡表面发现滋养体。然后患者被诊断为阿米巴结肠炎。
方法:经过2轮规范化的甲硝唑治疗,阿米巴结肠炎在服用二氧奈德之前仍然难治。
结果:患者仍无症状,年随访时结肠黏膜正常。
结论:新诊断为IBD的个体应进行必要的阿米巴病筛查。使用类固醇应该谨慎,特别是在美沙拉嗪的作用有限的情况下。对于有症状的肠道阿米巴病,即使在施用组织杀菌剂后,继续使用管腔内抗生素对防止复发是必要的。
BACKGROUND: Amebic colitis has been less prevalent in recent times in China, and the similarity of its symptoms to those of inflammatory bowel disease (IBD) results in the difficulty of early identification and diagnosis.
METHODS: A 31-year-old male who exhibited intermittent diarrhea and hematochezia was highly suspected as IBD initially. Despite the partial relief of symptoms following the administration of mesalamine, the endoscopic ulcers remained largely unchanged.
METHODS: Two years after the onset of mesalamine therapy, amebic cysts were detected in stool microscopy and trophozoites were found on the surface of cecal ulcers. The patient was then diagnosed with amebic colitis.
METHODS: After 2 rounds of standardized metronidazole treatment, amebic colitis remained refractory until diloxanide was administered.
RESULTS: The patient remained asymptomatic, and the mucosa of colon was normal during the annual follow-up.
CONCLUSIONS: Individuals newly diagnosed with IBD should undergo essential screening for amebiasis. And the use of steroids should be taken with caution, especially in cases where the effect of mesalamine is limited. For symptomatic intestinal amebiasis, even after the administration of tissue
amebicides, the continued use of luminal
amebicides is necessary to prevent recurrence.