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Scand J Gastroenterol. 2018 Sep;53(9):1085-1088. doi: 10.1080/00365521.2018.1500637. Epub 2018 Sep 26.

When IBD is not IBD.

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a Department of Gastroenterology and Hepatology , University Hospitals Leuven, KU Leuven , Leuven , Belgium.
b Department of Chronic Diseases, Metabolism and Ageing , Translational Research in Gastrointestinal Disorders (TARGID-IBD) , KU Leuven , Leuven , Belgium.


Entamoeba histolytica colitis can mimic Crohn's disease. However, a fulminant infection can be life-threatening, especially after exposure to systemic steroids. We present a case of the patient who was initially diagnosed with ileocolonic Crohn's disease, but developed a hepatic E histolytica abscess while undergoing anti-TNF therapy. After revision of the initial diagnostic biopsies, the diagnosis was questioned and E histolytica was confirmed using PCR and histopathology. As intestinal amoebiasis is the most common form of amoebic infection, care should be taken in case of refractory IBD or at initial diagnosis in patients who travelled to endemic areas. We therefore discuss the epidemiology, clinical features, diagnostic tools and pathophysiology of E Histolytica in order to raise awareness among gastroenterologists treating patients with inflammatory bowel disease.


Crohn’s disease; adalimumab; differential diagnosis; entamoeba

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