Abstract Sir.—Entamoeba histolytica can be responsible for a wide range of clinical conditions, varying in severity from the asymptomatic carrier state to fulminant colitis.1 Its role in causing chronic proctitis in children is less commonly appreciated. We present two children who developed painless rectal bleeding without diarrhea as the presenting symptom of chronic proctitis due to E histolytica. Patient Reports.—Patient 1.—An 8-year-old Hispanic boy developed rectal bleeding 1 month after returning from a 6-month stay in Mexico. He had no diarrhea, abdominal pain, fever, tenesmus, or mucus in his stools. Two weeks after the onset of painless hematochezia, results of the physical examination were normal, as were the hemoglobin, hematocrit, and white blood cell counts. Stool examinations for ova, parasites, and leukocytes had negative findings, and bacterial culture of the stool revealed no pathogens. A single-contrast barium examination of the colon showed it to be normal. During colonoscopy, References 1. Farthing MJG. Parasitic and fungal infections of the digestive tract . In: Walker WA, Durie PR, Hamilton JR, Walker-Smith JA, Watkins JB, eds. Pediatric Gastrointestinal Disease: Management and Pathophysiology . Philadelphia, Pa: BC Decker Inc; 1991:546-555. 2. Silverman A, Roy CC. Pediatric Clinical Gastroenterology . St Louis, Mo: CV Mosby Co; 1983:431-433. 3. Grove DI. Parasitic intestinal infections . In: Anderson CM, Burke V, Gracey M, eds. Pediatric Gastroenterology . Palo Alto, Calif: Blackwell Scientific Publications; 1987:306-318. 4. Lifshitz F, de Costa Ribiero H, Silverberg M. Childhood intestinal infections . In: Silverberg M, Daum F, eds. Textbook of Pediatric Gastroenterology . Chicago, Ill: Year Book Medical Publishers Inc; 1988:284-329. 5. Ravdin JL. Amebiasis . In: Wyngaarden JB, Smith LH, Bennett JC, eds. Cecil Textbook of Medicine . Philadelphia, Pa: WB Saunders Co; 1992:1994-1996. 6. Scully RF, ed. Case records of the Massachusetts General Hospital . N Engl J Med . 1977; 297:322-330.Crossref 7. Oyerinde JPO, Oguribi O, Alonge AA. Age and sex distribution of infections with Entamoeba histolytica and giardia intestinal in Lagos population . Int J Epidemiol . 1977;6:231-234.Crossref 8. Sanderson IR, Walker-Smith JR. Indigenous amoebiasis: an important differential diagnosis of chronic inflammatory bowel disease . Br Med J . 1984;289:823.Crossref 9. Kalani BP, Sogani KC. Amoebic rectal bleeding in children . Am J Proctol . 1975;26:67-70. 10. Merritt RJ, Coughlin E, Thomas DW, Jariwala L, Swanson V, Sinatra FR. Spectrum of amebiasis in children . AJDC . 1982;136:785-789. 11. Jammal MA, Cox K, Ruebner B. Amebiasis presenting as rectal bleeding without diarrhea in children . J Pediatr Gastroenterol Nutr . 1985;4: 294-296.Crossref 12. Ravdin JI, Petri WA. Entamoeba histolytica . In: Mandell GL, Douglas RG Jr, Bennett JE, eds. Principles and Practice of Infectious Diseases . 3rd ed. New York, NY: Churchill Livingstone Inc; 1990; chap 249:2036-2048. 13. Tucker PC, Webster PD, Kilpatrick ZM. Amebic colitis mistaken for inflammatory bowel disease . Arch Intern Med . 1975;135:681-685.Crossref 14. Giacchino JL, Pickleman J, Bartizal JF, Banich FE. The therapeutic dilemma of acute amebic and ulcerative colitis . Surg Gynecol Obstet . 1978;146:599-603. 15. Nelson, JD. Pocketbook of Pediatric Antimicrobial Therapy . 9th ed. Baltimore, Md: Williams & Wilkins; 1990:356.
American Journal of Diseases of Children – American Medical Association
Published: Sep 1, 1992