Intestinal amoebiasis and pediatric inflammatory bowel disease in an endemic region: Three case reports

Table 1 Clinical profile, therapeutic decisions and timeline of response in the three cases

Timeline/event	Case 1	Case 2	Case 3
Age at diagnosis	2 years	16 years	12 years
Current diagnosis	Follow up case of VEOIBD (UC) with flare	Follow up case of UC (steroid dependent) with flare	ASC
Prior immunosuppression	Azathioprine and infliximab	Azathioprine and 5-aminosalicylate	Intravenous corticosteroid (methylprednisolone)
Duration of disease	12 years	2 years	3 months
Stool microscopy findings	Trophozoites of E. histolytica	Trophozoites of E. histolytica	Trophozoites of E. histolytica
CMV status	Negative	Negative	CMV PCR (colonic biopsy-21000 copies/mg of tissue IHC negative
Anti-amoebic therapy	Metronidazole followed by diloxanide furoate	Metronidazole followed by diloxanide furoate	Metronidazole followed by diloxanide furoate
PUCAI at baseline	50	60	60
Duration in days before reassessment	3	5	7
PUCAI at reassessment	Improved to 40 then worsened 60	50	45
Reason for escalation of UC therapy	Worsening PUCAI	Suboptimal response	Suboptimal response
Escalation therapy given	Steroid short course, and scheduled dose of infliximab	Tofacitinib	Infliximab, gancylovir concomitant for CMV
Clinical response (PUCAI at discharge)	Yes, PUCAI 10	Yes, PUCAI 20	Yes, PUCAI 15
Follow-up outcome	In clinical remission	In clinical remission	In clinical remission

VEOIBD: Very early onset inflammatory bowel disease; UC: Ulcerative colitis; ASC: Acute severe colitis; E. histolytica: Entamoeba histolytica; CMV: Cytomegalovirus; PCR: Polymerase chain reaction; IHC: Immunohistochemistry; PUCAI: Pediatric ulcerative colitis activity index.