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

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]

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).

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; (e-pub ahead of print). doi: DOI: 10.1007/s12664-023-01355-7.

Publication History

Received: 06 April 2023

Accepted: 13 May 2023

Article published online:
20 February 2024