2648 A Case of Amebiasis in a Patient With Familial Hypertriglyceridemia Complicated by Recurrent Pancreatitis

Abstract

INTRODUCTION: Amebiasis disproportionately affects people in developing countries because poor sanitation conditions increase the risk for pathogen acquisition. In the United States, individuals who travel to endemic areas and men who have sex with men are two groups at higher risk of exposure. The following case highlights the importance of exposure history and avoiding anchoring bias. The patient’s constellation of symptoms could be explained by his history of chronic pancreatitis and pancreatic insufficiency, but upon further investigation he was also found have an infective enteritis. CASE DESCRIPTION/METHODS: A 44-year-old man with a past medical history significant for type 2 diabetes mellitus, idiopathic small fiber neuropathy, and familial hypertriglyceridemia complicated by recurrent pancreatitis was admitted for recurrent symptoms of nausea, vomiting, non-bloody diarrhea, and abdominal pain. Within the previous year, the patient had a PEG-J tube placement for nutritional support in the setting of severe pancreatitis complicated by acute fluid collections. On arrival to the emergency department, he was tachycardic and labs revealed a leukocytosis of 18 × 103 µL, lipase of 510 U/L, and normal LFTs. The CT scan showed a stable pancreatic pseudocyst and no suggestion of acute pancreatitis. Imaging did reveal mild thickening and dilated loops of small bowel consistent with enteritis in the left mid and left lower abdomen. Stool pathogen panel sent during previous admission had returned positive for Entamoeba histolytica (E. histolytica). The patient endorsed drinking well water from his backyard and using it to flush his PEG-J tube. DISCUSSION: The majority of amebiasis cases are asymptomatic, however 10% are associated with significant morbidity and mortality. E. histolytica is one of four species of intestinal amebae and the one related most to symptomatic disease. Malnutrition, which was present in our patient, is a risk factor for severe disease. Studies have shown that interaction between the host’s intestinal flora and E. histolytica may influence pathogenic behavior. Our patient's treatment regimen consisted of metronidazole, which is active against the trophozoite stage, and paromomycin, which eliminates intraluminal cysts. His source of exposure was likely the well water which was uncovered through a detailed exposure history.