Amebiasis cutis revisited.
BACKGROUND
Amebiasis cutis (AC) is reported infrequently. This study assesses the clinicopathological spectrum, co-existent visceral involvement and impact of human immunodeficiency virus (HIV) co-infection on AC.


METHODS
An 8-year prospective clinicopathological evaluation of patients with AC.


RESULTS
Thirty-one biopsies of ulcers, fistulae, fissures, abscesses, polypoid and warty lesions in perianal, penile, scrotal, vulval, buttock, chest and abdominal wall sites were evaluated. Of these, 11 had a 'superficial' (superficial AC) and 20 a 'deep' (deep AC), histopathological pattern. Superficial AC showed predominant epidermal spongiosis, liquefactive necrosis, ulceration and fissures with hematophagous amebic trophozoites (HATs). Deep AC had confluent deep dermal and subcutaneous liquefactive, coagulative or suppurative necrosis and HATs. Seven biopsies showed vasculitis or thrombosis with luminal HATs.


RESULTS
Fourteen patients died; 9 had concomitant visceral amebiasis, 5 had other co-infections. Six who died were HIV seropositive, three were seronegative; all had deep AC. Of the 17 survivors, 11 (8 HIV positive) had superficial AC that healed with metronidazole treatment; the remaining 6 (one HIV seropositive) required additional surgical intervention.


CONCLUSIONS
Deep AC is predictive of co-existent, contiguous visceral disease. The effective management, histopathological mimickers and diagnostic pitfalls of superficial and deep AC differ. The outcome in HIV-infected patients is dependent on co-existent systemic diseases.
Ramdial
Pratistadevi K
PK
Department of Pathology, Nelson R Mandela School of Medicine, University of KwaZulu Natal and Inkosi Albert Luthuli Central Hospital, Congella 4013, Durban, KwaZulu Natal, South Africa.
Calonje
Eduardo
E
Singh
Bhugwan
B
Bagratee
Jayanthilall S
JS
Singh
Shivon M
SM
Sydney
Clive
C
D017088:AIDS-Related Opportunistic Infections / Q000401:mortality / Q000469:parasitology / Q000473:pathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000562:Amebiasis / Q000401:mortality / Q000473:pathology*; D001706:Biopsy; D019353:Endemic Diseases; D004817:Epidermis / Q000469:parasitology / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012871:Skin Diseases / Q000401:mortality / Q000469:parasitology* / Q000473:pathology*; D013019:South Africa / Q000453:epidemiology; D015996:Survival Rate