When IBD is not IBD

Abstract

Entamoeba histolytica colitis can mimic Crohn’s disease. However, a fulminant infection can be life-threatening, especially after exposure to systemic steroids. We present a case of the patient who was initially diagnosed with ileocolonic Crohn’s disease, but developed a hepatic E histolytica abscess while undergoing anti-TNF therapy. After revision of the initial diagnostic biopsies, the diagnosis was questioned and E histolytica was confirmed using PCR and histopathology. As intestinal amoebiasis is the most common form of amoebic infection, care should be taken in case of refractory IBD or at initial diagnosis in patients who travelled to endemic areas. We therefore discuss the epidemiology, clinical features, diagnostic tools and pathophysiology of E Histolytica in order to raise awareness among gastroenterologists treating patients with inflammatory bowel disease.

Keywords:

• Crohn’s disease
• entamoeba
• differential diagnosis
• adalimumab

Acknowledgments

We would like to thank all our colleagues who were involved in unravelling this case: Gert De Hertogh, MD, PhD (Department of Imaging & Pathology, Translational Cell & Tissue Research, KU Leuven, Leuven, Belgium); Dirk Vanbeckevoort, MD (Department of Radiology, University Hospitals Leuven, Leuven, Belgium); Katrien Lagrou, MD, PhD (Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium); Baki Topal, MD, PhD (Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium); Hannah van Malenstein, MD, PhD (Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium); Wim Laleman, MD, PhD (Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium).

Disclosure statement

B Verstockt received speakers fee from Ferring Pharmaceuticals and Takeda.

S Vermeire received financial support for research from MSD, Abbvie and UCB Pharma; lecture fees from Abbott, Abbvie, Merck Sharpe & Dohme, Ferring Pharmaceuticals and UCB Pharma; consultancy fees from Pfizer, Ferring Pharmaceuticals, Shire Pharmaceuticals Group, Merck Sharpe & Dohme, and AstraZeneca Pharmaceuticals.

G Van Assche received financial support for research from Abbott and Ferring Pharmaceuticals; lecture fees from Janssen, MSD and Abbott; consultancy fees from PDL BioPharma, UCB Pharma, Sanofi-Aventis, Abbott, Abbvie, Ferring, Novartis, Biogen Idec, Janssen Biologics, NovoNordisk, Zealand Pharma A/S, Millenium/Takeda, Shire, Novartis and Bristol Mayer Squibb.

M Ferrante received financial support for research from Takeda; lecture fees from Ferring, Boehringer-Ingelheim, Chiesi, Merck Sharpe & Dohme, Tillotts, Janssen Biologics, AbbvieTakeda, Mitsubishi Tanabe, Zeria; consultancy fees from Abbvie, Boehringer-Ingelheim, Ferring, Merck Sharpe & Dohme, and Janssen Biologics.

The authors have no other relevant affiliations or financial involvement with any organisation or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

B Verstockt is a doctoral fellow and S Vermeire, G Van Assche and M Ferrante are Senior Clinical Investigators of the Research Foundation Flanders (FWO), Belgium. B Verstockt has also received research grants by the Belgium Week of Gastroenterology, the Belgian IBD Research and Development (BIRD) and the European Crohn’s and Colitis Organisation (ECCO).