title: Ameboma: an unusual cause of gastrointestinal bleeding during severe leptospirosis.
abstract: BACKGROUND
  Severe leptospirosis occurs mainly in a tropical environment and includes icterus, acute renal failure and hemorrhages. These bleedings, which are mainly a consequence of acute homeostatic disturbances, can also reveal simultaneous diseases. Coinfections with other tropical diseases have been previously reported during leptospirosis. To our knowledge, invasive amebiasis, which can induce gastrointestinal bleedings, has never been described in the course of severe leptospirosis.
  
  
  METHODS
  In this report, we describe a case of a 60 year-old man living in Reunion Island (Indian Ocean, France) admitted to our intensive care unit for severe Leptospira interrogans serovar icterohaemorrhagiae infection with neurological, renal, liver and hematological involvement. Two lower gastrointestinal bleedings occurred 7 and 15 days after admission. The first episode was promoted by hemostatic disturbances while the second bleeding occurred during low-dose heparin therapy. Colonoscopy revealed a pseudo-tumoral inflammatory mass of the recto-sigmoid junction. Histological examination found trophozoites inside mucinous exudate suggestive of Entamoeba histolytica. Amoebic serology was strongly positive whereas careful detection of cysts or trophozoites on saline-wet mount was negative in three consecutive samples of stools. Amoxicillin followed by metronidazole therapy, combined with supportive care, led to an improvement in the clinical and biological patient's condition and endoscopic appearances.
  
  
  CONCLUSIONS
  Clinicians should be aware that gastrointestinal bleeding during severe leptospirosis could not solely be the consequences of hemostatic disturbances. Careful endoscopic evaluation that may reveal curable coinfections should also be considered.
authors.affiliation: Service de Néphrologie, Dialyse et Transplantation Rénale, Centre Hospitalier Universitaire Felix Guyon, Saint-Denis, La Réunion, France. tristan.legris@ap-hm.fr.
authors.forename: Tristan
authors.initials: T
authors.lastname: Legris
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Jaffar-Bandjee
authors.forename: Olivier
authors.initials: O
authors.lastname: Favre
authors.forename: Nicole
authors.initials: N
authors.lastname: Lefrançois
authors.forename: Robert
authors.initials: R
authors.lastname: Genin
authors.forename: Claire
authors.initials: C
authors.lastname: Ragot
authors.forename: Carla
authors.initials: C
authors.lastname: Fernandez
authors.forename: Anne-Hélène
authors.initials: AH
authors.lastname: Reboux
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D003937:Diagnosis, Differential; D004748:Entamoeba histolytica / Q000302:isolation & purification*; D004749:Entamoebiasis / Q000150:complications / Q000175:diagnosis*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D007565:Jaundice / Q000209:etiology; D007922:Leptospirosis / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged