A 31-year-old woman presented with acute right lower abdominal distress that had lasted for two days before admission. Her medical history showed numerous bouts of right lower abdominal pain that settled with conservative treatment. She had no history of traveling overseas or an STI. On admission, her body temperature was 37.5 °C. Abdominal examination revealed diffuse tenderness in the right lower abdomen with positive guarding and rebound tenderness at the McBurney point. Laboratory tests revealed a C-reactive protein (CRP) level of 15.06 mg/dL and a white blood cell (WBC) count of 8620 μL−1. Abdominal computed tomography (CT) showed a dilated appendix with a maximum diameter of 2 cm and thickened caecal and ascending colon wall. Considering the patient's request, she was administered antibiotics (intravenous cefmetazole) for two days without improvement. Therefore, an appendectomy was performed. Her appendix showed acute inflammation, especially from the cecum to the root of the appendix, without necrosis, perforation, or localized abscess formation.
After the appendectomy, her body temperature continued >38 °C, and her CRP and WBC were elevated more than before the operation. On the third postoperative day, the Abdominal CT revealed thickened caecal and ascending colon walls. The test for Clostridium difficile was negative, and her symptoms and laboratory data did not improve. On the sixth postoperative day, fecal culture was tested for serum amebic antibody. The pathologic examination of the appendix with periodic acid–Schiff (PAS) stain revealed multiple trophozoites of Entamoeba histolytica, and her serum amebic antibody was positive.
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