Amebiasis Presenting as Acute Appendicitis: Case Report

Amoebiasis presenting as acute appendicitis is a rarity. A search of the literature revealed recent accounts of individual cases from countries as far apart as Japan, India, Egypt, and Kuwait [1-4]. Therefore, a Nigerian case is deemed to be worthy of documentation. Histopathologic examination revealed the unexpected presence of Eutameba histolytica instead of the ordinary inflammation.

A 30-year-old man of the Igbo ethnic group attended the Oko Community Hospital complaining of pain in the abdomen with nausea since 2 days [5]. He was examined by one of us (OE). There was classical tenderness in the right iliac fossa, the Rovsing's sign being positive. At the operation, the appendix showed adhesions and was removed. On receipt by the co-author (WO), it was a diminutive 4cm appendix with fecal matter. On microscopy, there were luminal pus cells as well as typical E histolytica parasites showing ingested red blood corpuscles. There was uneventful recovery following metronidazole treatment.

In a Japanese contribution, the amebic element was complicated by HIV-1-infection [6]. This was not the issue in our case. Turkish authors obtained a total of174 cases of amebic appendicitis using the PubMed and MEDLINE databases [7]. The mean age of the patients was 23.5 years (range 2 months-83 years). In other words, our local patient aged 30 years is typical. Moreover, male preponderance is typical. Birmingham (UK) authors stressed that the establishment of a histopathology data pool improves epidemiological analysis [8]. Indeed, it was such a Regional Laboratory that helped matters in our patient. Incidentally, there was some debate in the UK about the usefulness of a central laboratory in terms of distant researchers [9]. As argued elsewhere, the usefulness is clear especially in a developing community [10]. Furthermore, USA authors concluded from a total of 93 reported cases that "The condition is suspected clinically whenever a cecum of hard, 'cardboard-like' consistency is discovered" [11]. Our experience of the cecum was not of such a consistency.

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