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CC BY-NC-ND 4.0 · Journal of Gastrointestinal Infections 2024; 14(01): 031-032
DOI: 10.1055/s-0043-1770158
Images in GI Infection

Images in Gastrointestinal Infections: Dual Infection of Enterobius vermicularis and Entamoeba histolytica in a Case with Bloody Diarrhea

Rinkalben Kakadiya 
1   Department of Gastroenterology, Surat Institute of Digestive Science, Surat, Gujarat, India
,
Mayank Kabrawala
1   Department of Gastroenterology, Surat Institute of Digestive Science, Surat, Gujarat, India
,
Pankaj Desai
2   Department of Gastrointestinal Endoscopy, Surat Institute of Digestive Science, Surat, Gujarat, India
,
Priya Arora
3   Department of Pathology, Surat Institute of Digestive Science, Surat, Gujarat, India
› Author Affiliations
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A 27-year-old woman presented to the emergency department with chronic bloody diarrhea for 6 weeks. She had a stool frequency of five to seven per day. Her physical and per rectal examinations were normal. Investigations revealed anemia with hemoglobin of 9.7% and red blood cells in stool examination. Colonoscopy revealed a few ulcers in the cecum, ileocecal valve ([Fig. 1a]), and rectum ([Fig. 1b]). Histopathology examination of cecal biopsy revealed Enterobius vermicularis (pinworm; [Fig. 1c]). However, symptoms and endoscopic findings could not be explained by E. vermicularis alone. The biopsy and colonoscopy findings did not suggest inflammatory bowel disease. On careful histopathology slide review, trophozoites of Entamoeba histolytica were seen in cecal and rectal biopsy ([Fig. 1d]). The patient was treated with metronidazole, diloxanide furoate, and albendazole. The patient's symptoms improved. In this case, the clinical presentation was inconsistent with E. vermicularis infection, which was obvious in the initial examination. A few trophozoites of E. histolytica were discovered on diligent review of histopathology. This case highlights the importance of keeping broad differentials and reviewing all investigations when discordancy with a clinical profile exists.[1]

Zoom Image
Fig. 1 Colonoscopy images of (a) ulcers in the cecum and (b) erosion and erythema in the rectum. Histopathology with hematoxylin and eosin (H&E) stain (c) cross-section image of Enterobius vermicularis (black arrow) and (d) trophozoites of Entamoeba histolytica (black arrow).

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Conflict of Interest

None declared.

Acknowledgment

None.

Ethical Statement

Not applicable for the images. Informed consent was taken from the patient.


Authors' Contribution

All the authors contributed equally to the article.


Data Availability Statement

There are no data associated with this work.


  • References

  • 1 Sethi S, Nayak HK, Panigrahi C, Patra S, Panigrahi MK, Samal SC. Double infection in Crohn's disease. Indian J Gastroenterol 2023; 42 (05) 731-733
    CrossrefPubMedSearch in Google Scholar

Address for correspondence

Rinkalben Kakadiya, DM Gastroenterology
Surat Institute of Digestive Science, SIDS Hospital
Majura Gate, Ring Road, Surat, Gujarat
India   

Publication History

Received: 06 April 2023

Accepted: 13 May 2023

Article published online:
20 February 2024

© 2024. Gastroinstestinal Infection Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Sethi S, Nayak HK, Panigrahi C, Patra S, Panigrahi MK, Samal SC. Double infection in Crohn's disease. Indian J Gastroenterol 2023; 42 (05) 731-733
    CrossrefPubMedSearch in Google Scholar

   Permissions and Reprints
Zoom Image
Fig. 1 Colonoscopy images of (a) ulcers in the cecum and (b) erosion and erythema in the rectum. Histopathology with hematoxylin and eosin (H&E) stain (c) cross-section image of Enterobius vermicularis (black arrow) and (d) trophozoites of Entamoeba histolytica (black arrow).