從結節性紅斑到阿米巴痢疾－國際醫療病例分析

From Erythema Nodosum to Amoebiasis - A Case Learned from International Medicine Clinic

黃崧溪(Sung-Hsi Huang) ； 陳宜君(Yee-Chun Chen) ； 翁昭旼(Jau-Min Wong) ； 邱顯清(Hsien-Ching Chiu)

《內科學誌》 26卷6期 (2015/12) Pp. 313-318

https://doi.org/10.6314/JIMT.2015.26(6).01

摘要

基於全球化的影響，在台灣的醫師有越來越多的機會可能接觸到世界各地的傳染性疾病。本文描述一位58歲在台工作的德國人，因全身散發性疼痛紅色結節持續兩週就醫。Ａ醫院投與類固醇，病灶初始有改善，但在類固醇使用中紅疹復發。至Ｂ醫院就醫後，詳細病史詢問，病人單身，之前被派駐印尼雅加達工作四個多月。檢查發現白血球18.45 k/μL，血小板538 k/μL，CRP 5.12 mg/dL，鹼性磷酸酶、麩胺醯轉肽酶也上昇。電腦斷層檢查橫結腸較為腫脹，黏膜顯影較為明顯。大腸鏡檢查發現在盲腸及升結腸多處表淺潰瘍伴隨有表面滲出物。病理切片發現結腸黏膜局部糜爛，滲出物中有阿米巴滋養體。血清之indirect hemagglutination for amoeba檢查陽性(1:256)。通報疾病管制署，送驗糞便檢體Entamoeba histolytica PCR陽性。病人接受口服metronidazole治療十天，接著使用七天paramomycin以廓清腸道阿米巴囊胞體。紅斑在針對阿米巴治療後也改善。以結節性紅斑來表現的阿米巴痢疾實屬罕見，文獻中僅有兩例。考量結節性紅斑多為免疫反應之表現，此等病人應積極針對潛在病因檢查。

關鍵字

結節性紅斑 ； 阿米巴痢疾 ； 旅遊醫學

並列摘要

A 58-year-old German working in Taiwan presented to this hospital with the complaint of painful erythematous nodules and plaques for more than 2 weeks. Steroid and non-steroidal anti-inflammatory drugs had been given at a regional hospital with transient partial response followed by rebound of local symptoms and progression of leukocytosis. He has been stayed for 4 months in Jakarta, Indonesia. He denied history of previous pharyngitis or sulfonamide exposure. Erythema nodosum was diagnosed and a diagnostic process for potential etiologies was began. An abnormal alkaline phosphatase and γ-glutamyl transpeptidase lead to an abdominal computed tomography, which disclosed edematous transverse colon with increased mucosal contrast enhancement. At the same time the patient reported new fresh-blood-tinged stool passage. A colonoscopy revealed multiple ulcers at ascending colon. Serum indirect hemagglutination test for amoeba was positive (titer 1:256). Biopsy of the colon revealed amoebic trophozoite with erythrocyte phagocytosis. Stool PCR for Entamoeba histolytica was positive at CDC laboratory. Amoebic colitis in a HIV-negative healthy adult was diagnosed. Erythema nodosum is a rare presenting symptom for amoebiasis. There were only two cases reported in the literature. Considering erythema nodosum is an immune-mediated presention, diagnostic approach for underlying etiology is paramount important particularly when steroid therapy is considered.

並列關鍵字

Erythema nodosum ； Entamoeba histolytica ； Travel medicine