2026年 · 第106卷第05期

The patient, a 54-year-old male, was admitted to the Third Hospital of Peking University on June 26, 2024 due to "blood in the stool for 3 months". Three months ago, the patient had blood in the stool without obvious trigger, which was bright red and coffee-colored stool alternately, shaped soft stool, accompanied by abdominal pain and abdominal distension, which was slightly aggravated in the past 3 weeks, about 3 to 4 times/d, occasionally visible mucus, pus and blood in the stool, accompanied by severe feeling after tenesmus, the correlation with eating was unclear, and there were no other complaints of discomfort. There was no family history of gastrointestinal tumor and no history of travel outside the epidemic area. The whole body examination is nothing special. Colonoscopy: Scattered irregular ulcers of different sizes can be seen in the cecum, appendix and upper segment of ascending colon (Figure 1, shown by arrows), with congestion around the ulcers and dirty coating attached to the surface. There are multiple irregular ulcers from 18 cm in the rectum to the anus (Figures 2 and 3, shown by arrows). Some ulcers are crater-shaped with different sizes. The surrounding mucosa is congested and edematous, the mucosa is rough and uneven, and the surface is attached to dirty coating, accompanied by spontaneous bleeding. The biopsy part is brittle. Endoscopic diagnosis: the nature of multiple ulcers in the cecum, ascending colon and rectum is to be determined. Pathology suggests proximal ileocecal valve ulcer of ascending colon: chronic active inflammation of mucosa with ulcer formation, inflammatory exudation and necrosis, basically regular crypt arrangement, occasional cryptitis, formation of lymphoid follicles in lamina propria, and amoebic trophozoites (Figure 4, HE staining ×400, indicated by arrows); (Rectal ulcer) Chronic active inflammation of the mucosa with necrosis and exudation, with amoebic trophozoites visible. Special staining results: Schiff periodate stain (PAS) (+), hexamine silver periodate stain (PASM) (+). Polymerase chain reaction Mycobacterium tuberculosis nucleic acid detection (PCR-TB) (-). Consistent with amoebic enteritis. Perfect inspection and examination, no other organ involvement. In summary, the diagnosis of amoebic enteropathy is clear and there is no involvement of peripheral organs. Metronidazole combined with diclonide was intermittently treated for 90 days. After 1 month of stopping the drug, colonoscopy was repeated: only a little erythema in the rectum, and the pathology suggested chronic active inflammation of the mucosa. Follow-up until January 14, 2025, and endoscopy revealed cure.