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  In this article
   Abstract
   Introduction
   Case Report
   Comments
   References

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CASE REPORT
Year : 1993  |  Volume : 59  |  Issue : 5  |  Page : 254-255

Cutaneous ameobiasis masquerading as epithelioma




Correspondence Address:
H R Chandrasekhar


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  Abstract 

A case of cutaneous amoebiasis, clinically diagnosed as epithelioma, presenting as an ulcer in the perianal region, in a 30-year old male is reported. The patient was successfully treated with metronidazole.


Keywords: Amoebiasis


How to cite this article:
Chandrasekhar H R, Shashikala P, Kumar P, Bas. Cutaneous ameobiasis masquerading as epithelioma. Indian J Dermatol Venereol Leprol 1993;59:254-5

How to cite this URL:
Chandrasekhar H R, Shashikala P, Kumar P, Bas. Cutaneous ameobiasis masquerading as epithelioma. Indian J Dermatol Venereol Leprol [serial online] 1993 [cited 2019 Aug 18];59:254-5. Available from: http://www.ijdvl.com/text.asp?1993/59/5/254/3947



  Introduction Top


Amoebiasis has a worldwide distribution but it is very much common throughout the tropics including India. The magnitude of the problem depends on the incidence in the community and feeding habits.

Amoebic ulcers are more common in caecum and rectum. Complications either result from migration of amoebae through bowel wall or following invasion of veins. Entamoeba histolytica can spread from bowel to other organs producing extraintestinal or metastatic amoebiasis. Organs usually affected are lungs and liver, cutaneous amoebiasis being uncommon.


  Case Report Top


A 30-year-old agriculturist was admitted with the sole complaint of a painful ulcer around the anus, of 8 months duration. His general physical and systemic examinations were unremarkable, except for bilateral, small nontender inguinal lymphadenopathy. Local examination revealed tender perianal ulcer, 3 cms in diameter, with raised, everted margins and necrotic debris in the floor. Routine laboratory investigations, chest X-ray and abdominal scan were normal. Stool examination was negative for ova and cyst. With a diagnosis of epithelioma, with secondaries in the inguinal lymph nodes, the ulcer was excised.

Light microscopy showed epidermis with acanthosis and pseudo - epitheliomatous hyperplasia, with focal superficial ulcer containing necrotic debris, plenty of large round amoebae with a single round basophilic nucleus, foamy cytoplasm and erythrophagocytosis. Dermis showed proliferated capillaries, dense infiltration of plasma cells, lymphocytes, eosinophils and few foreign-body type of giant cells. Iron haematoxylin stain highlighted amoebae. Patient responded to metronidazole.


  Comments Top


Cutaneous amoebiasis is rare with isolated case reports. [1],[2][3] Cutaneous amoebiasis occurs in four distinct situations: from perforation of an abscess or intestine into skin; from surgical wounds infected secondarily with an intestinal amoebic lesion; as a primary focus in the ocular orbit, the face and other sites, and finally in the perineal genital area [4],[5]

There was no history of diarrhea and stool examination was negative for amoebae in our case. Patient possibly was a carrier and ulcer was due to direct extension from rectum or fecal contamination. Inguinal lymphadenopathy was considered nonspecific since the patient worked in fields and walked bare foot.

It is important to remember that history of diarrhea is not essential in making a diagnosis of cutaneous amoebiasis. Presence of Entamoeba histolytica in the stool is not necessarily accompanied by clinical amoebiasis. Multiple fresh stools may need to be examined by experienced laboratory personnel. Because stool examination is difficult, and can lead to both under and over diagnosis, serodiagnosis has become useful. A definite diagnosis depends on recognition of Entamoeba histolytica in the lesions. With prompt diagnosis and appropriate therapy, lesions heal rapidly. If untreated, the disease may be fatal particularly in infants.

 
  References Top

1.Abdus Sattar AB. An unusual cutaneous amoebic ulcer. JTrop Med Hyg 1979; 82: 201-2.  Back to cited text no. 1  [PUBMED]  
2.Wynne JM. Perineal amoebiasis. Arch Dis Child 1980; 55:234-5.  Back to cited text no. 2  [PUBMED]  
3.Majmudar B, Chaiken M, Lee KV. Amoebiasis of clitoris mimicking carcinoma. JAMA 1976; 236: 1145-6.  Back to cited text no. 3    
4.Gutierrez. Diagnostic pathology of parasitic infections with clinical correlations. Philadelphia: Lea and Febiger, 1990; 69-70.  Back to cited text no. 4    
5.James HG,,Waine CJ, Elso BH. Dermal Pathology, 1st Ed. New York Harper & Row, 1972: 253.  Back to cited text no. 5    



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