Article in Japanese

A 1-year-old child with difficult to diagnose amoebic dysentery and no history of foreign travel

Yuka HANAKI^1） , Sayaka OKUZONO^1） , Hikaru KANEMASA^1） , Yoshitomo MOTOMURA^1） , Masataka ISHIMURA^1） , Shouichi OHGA^1）

Amoebic dysentery infection, which produces bloody stools, is caused by Entamoeba histolytica. It occurs mainly in developing countries through waterborne infections, due to unsanitary conditions. However, cases of amoebic dysentery in children with no history of overseas travel are rare in Japan. Here, a case of amoebic dysentery with persistent bloody stools is reported in a 1-year 5-month old girl who had never travelled abroad. The diagnosis was confirmed 1 year after the first examination. The patient had bloody stools, and a stool culture detected no significant bacteria. Lower gastrointestinal endoscopy revealed a series of lymphoid follicle-like elevations, multiple aphtha-like erosions, and ulcers in the ascending colon and rectum. The girl was investigated for food protein-induced gastroenteritis and very early onset of inflammatory bowel disease, but no diagnosis was reached. The patient had no other symptoms and was in good general condition, but she presented with persistent bloody stools, anemia and hypogammaglobulinemia. One year after the onset of disease, biopsy pathology of the lower gastrointestinal tract revealed amoebic dysentery, and the patient responded to oral metronidazole. There was no history of overseas travel or family infection, and the route of transmission could not be determined. Amoebic dysentery is rare in Japanese infants, and useful tests for diagnosis are difficult to obtain, due to problems with insurance coverage.

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1） Department of Pediatrics, Graduate school of Medical Sciences, Kyushu University

Key words	amoebic dysentery, very early onset inflammatory bowel disease；VEO-IBD, food-protein-induced enterocolitis syndrome；FPIES, polymerase chain reaction；PCR
Received	June 13, 2022
Accepted	September 28, 2022

34 (4)：271─277,2022