Metronidazole and Tinidazole-resistant Amebic Colitis with Various Endoscopic Findings, Report of a Case Kazuya Makiyama 1 , Masahiro Suenaga 1 , Soutetsu Ri 1 , Kouhei Hara 1 , Itirou Sekine 2 1The Second Department of Internal Medicine, Nagasaki University, School of Medicine 2Department of Pathology, Atomic Disease Institute, Nagasaki University, School of Medicine pp.93-98
Published Date 1985/1/25
DOI https://doi.org/10.11477/mf.1403109672
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 A 73 year-old man with chief complaints of diarrhea and lower limb edema was admitted to our hospital on April 18, 1983. Ten months prior to this admission, he had frequent watery mucous diarrhea. Under a diagnosis of ulcerative colitis, oral salazopyrine and steroid enema therapy were given. On this admission, the colonofiberscopic finding showed geographical abnormal red areas mainly from middle Houston valve to sigmoid, much different from the previous findings (edema, hyperemia and erythema.) Numerous cysts of Entamoeba histolytica were found from mucous stool and the diagnosis of amebic colitis was made with negative serological test for E. histolitica. Metronidazole and tinidazole were administered without effect. After combination therapy with dehydroemetine 45mg/day i.m. for 10 days, the symptom subsided finally. Protein-loosing gastroenteropathy (T.P. 4.8g/dl) confirmed by 131I-RISA test on admission was also cured.

 Being ineffective of treatment with metronidazole and tinidazole, it is considered that there exists ameba resistant to these drugs although resistant strain to metronidazole has not been found in in vitro test yet.

 It is not easy to find cyst from patient with chronic intestinal amebiasis, even if amebiasis is suspected from clinical symptoms and endoscopic findings. Definite diagnosis is often difficult. Furthermore, many patients with chronic intestinal amebiasis are treated as ulcerative colitis from the beginning, so it is often experienced that characteristic endoscopic findings are much modified just as seen in our patient. This is considered a main cause for making the diagnosis difficult.

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