Fulminant Amebic Colitis Complicated by Appendiceal Perforation and Massive Abdominal Hemorrhage: A Case Report and Literature Review

Xin Zhang¹Wenxiong Li²Song Zhao²Yue Han²Wenliang Ma²Zhaoyang Jiang²Youwei Ma²Guichen Zhang²Jingyi Wang²Huimiao Jia²Shuyan Guo²Na Cui^2*

• ¹Beijing Chest Hospital, Capital Medical University, Beijing, China
• ²Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China

Introduction Fulminant amebic colitis complicated by intestinal perforation or massive intra-abdominal hemorrhage is uncommon but associated with extremely high mortality. In non-endemic regions, diagnosis is frequently delayed because early manifestations resemble bacterial appendicitis or perforated peritonitis. Case presentation We report a fatal case of Entamoeba histolytica infection presenting with appendiceal perforation, septic shock, and recurrent intra-abdominal bleeding. Surgery revealed extensive transmural necrosis, deep ulcers, and exposure of submucosal vessels. Metagenomic next-generation sequencing (mNGS) of blood and peritoneal drainage fluid was performed, followed by histopathological confirmation. Despite emergent appendectomy, bowel resection, and prompt initiation of anti-amebic therapy, the patient developed refractory septic shock and recurrent intra-abdominal hemorrhage, resulting in death. Conclusions mNGS can facilitate early recognition of severe amebiasis when conventional diagnostic modalities are uncertain, particularly in non-endemic settings. Fulminant amebic colitis complicated by perforation or hemorrhage carries a poor prognosis. Timely clinical suspicion and early anti-amebic therapy are essential to improve outcomes.