<Presentation of a
Case>
The 52-year-old man was admitted to this hospital because
of fever and diarrhea for 4 weeks.
He had been otherwise well without
known systemic diseases before, with exception of an episode
of herpes zoster 5 years earlier before this hospitalization.
He had lived in Japan with his Japanese wife and a child over
the past 11 years and returned to Taiwan 2 years earlier. Four
weeks earlier prior to this admission, he began to develop
intermittent fevers and diarrhea without vomiting. He had no
recent travel abroad. The stools were loose, which appeared to
contain blood streaks. He sought medical attention at several
clinics and took medicines without benefit. The symptoms
continued, followed by progressive epigastric discomfort. He
was seen at another hospital where physical examination
disclosed tenderness at the right lower quadrant and
epigastric region. There was no jaundice, visual defects,
lymphadenopathies or rebound tenderness of the abdomen. Chest
and heart examinations were negative. Examination of the stool
specimens revealed 4+ for occult blood and numerous
leukocytes. White blood cell count was 6060 x 106/L
with 61.4% neutrophils and 27.1% of lymphocytes; hemoglobin
was 13.2 g/dl; and platelet count was 327 x 109
/L. GOT was 66 IU/L; ƒ×-GT was 219 IU/L and alkaline
phosphatase was 488 IU/L.
Abdominal sonography and abdominal computed tomographic
(CT) scan showed colonic wall thickening and three hepatic
abscesses with thick walls at the right lobe. Ceftriaxone and
metronidazole were instituted. CT scan-guided drainage was
performed to yield chocolate-like fluid, in which Gram-stain
smears did not reveal bacteria or protozoa. Colonoscopy
identified multiple ulcers from ascending to descending colon.
The ileum was spared. Pathology of the biopsy revealed
flask-shaped ulcers, in which numerous Entamoeba histolytica
with ingestion of red blood cells were identified. The titer
of indirect hemaglutination (IHA) assay was 1:8192. Cultures
of the liver aspirate were negative for bacteria. Monotherapy
with metronidazole was continued for amebic liver abscess and
colitis.
After consultation with an infectious diseases
specialist, the patient agreed to an anti-HIV antibody test,
which yielded positive by ELISA. Western blot test was also
positive for HIV-1 after he was referred to this hospital.
Baseline CD4 lymphocyte count was 223 x 106
/L, and plasma HIV-RNA load was 77,000
copies/ml by RT-PCR. He admitted to having been a homosexual
and having had multiple un-protected sexual encounters in
Japan and Taiwan. He also reported that he had had ora-anal
sexual practice.
<®×¨Ò»P°ÝÃD¤ÀªR> <·R´þ¯f¬r·P¬V»Pµg¯eªü¦Ì¤ÚìÂηP¬V>
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