Cureus最新文献

{"title":"The Association Between Possible Sarcopenia and Delirium Onset in Older Patients With Acute Stroke.","authors":"Kaori Shiozaki, Ayano Nagano, Mariko Hanaoka, Yuki Uchiyama, Kazuhisa Domen, Tetsuo Koyama","doi":"10.7759/cureus.86993","DOIUrl":"https://doi.org/10.7759/cureus.86993","url":null,"abstract":"<p><p>Introduction Delirium is a common and serious complication among older adults hospitalized with acute stroke, and it is associated with increased morbidity, mortality, and prolonged hospital stays. Sarcopenia, characterized by a decline in muscle mass and strength, has emerged as a potential risk factor for delirium. However, there has been scarce research exploring this relationship in stroke populations. This study aimed to investigate the association between possible sarcopenia and the onset of delirium in older patients with acute stroke. Methods We conducted a retrospective cohort study of patients aged 65 years and older admitted to the Stroke Care Unit of a single institution between April 2020 and March 2021. Possible sarcopenia was defined using the AWGS2019 criteria based on grip strength and calf circumference. Delirium was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria by a certified dementia care team. Clinical characteristics and known delirium risk factors were extracted from medical records. Logistic regression analysis was performed to identify independent predictors of delirium. Results Of the 543 patients screened, 486 were included in the final analysis. Possible sarcopenia was identified in 187 patients (38.4%). Delirium occurred in 46 patients (9.4%), and its incidence was significantly higher in the sarcopenia group (15.0%) than in the non-sarcopenia group (6.0%, p=0.001). Multivariate logistic regression analysis revealed that possible sarcopenia was independently associated with delirium onset [odds ratio (OR): 1.98, 95% confidence interval (CI): 1.01-3.91, p=0.048], second only to a history of delirium. Conclusions Our findings suggest that possible sarcopenia is a significant and independent predictor of delirium in older patients with acute stroke. Early identification of sarcopenia may facilitate targeted interventions to reduce delirium risk and improve clinical outcomes in this vulnerable population.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86993"},"PeriodicalIF":1.0,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12206565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simultaneous Onset of Acute Myeloid Leukemia and Decompensated Cirrhosis: A Rare Case.","authors":"Wilfredo J Javier-Rojas, Alvin B Newman-Caro, Yizhi Lin, Carlos Montero","doi":"10.7759/cureus.86990","DOIUrl":"https://doi.org/10.7759/cureus.86990","url":null,"abstract":"<p><p>Acute myeloid leukemia (AML) is a hematologic malignancy marked by uncontrolled proliferation of abnormal myeloid precursor cells, while cirrhosis involves progressive hepatic fibrosis and architectural distortion. Despite differing pathophysiologies, both can present with overlapping clinical features, complicating the diagnostic process. We present the case of a 78-year-old female with a one-month history of bilateral lower extremity edema, dyspnea, fatigue, anorexia, low-grade fever, and progressive abdominal distension. Upon admission, a comprehensive metabolic panel revealed mild transaminitis, hyperbilirubinemia, and hypoalbuminemia. Complete blood count with differential revealed moderate leukocytosis, macrocytic anemia below the transfusion threshold, severe thrombocytopenia, and 10% circulating blasts. A contrast-enhanced computed tomography scan of the abdomen and pelvis showed cirrhotic liver morphology, portal hypertension, esophageal varices, splenomegaly with infarct, and minimal ascites. Chronic liver disease workup also indicated possible hereditary hemochromatosis. Hematologic evaluation, including peripheral blood flow cytometry, confirmed AML with 11.4% blasts expressing CD34, CD117, HLA-DR, CD33, and CD13. This case highlights the rare concurrent presentation of newly diagnosed AML and cirrhosis, emphasizing the diagnostic challenges posed by overlapping symptoms and the necessity of a multidisciplinary approach for timely identification and management.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86990"},"PeriodicalIF":1.0,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12206544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Overweight and Obesity Among Adults and Their Association With Diabetes, Hypertension, and Dyslipidemia: A Comparative Cross-Sectional Study in Urban and Rural Areas of the Etawah District.","authors":"Lokesh Raheja, Divyata Sachan, Prashant K Bajpai, Naresh P Singh, Ajai Kumar, Dhiraj K Srivastava, Sushil K Shukla","doi":"10.7759/cureus.86946","DOIUrl":"https://doi.org/10.7759/cureus.86946","url":null,"abstract":"<p><p>Introduction Obesity is not technically a terminal illness, yet it is a significant risk factor for numerous severe non-communicable diseases (NCDs). It is a condition characterized by excessive fat accumulation in the body, which can negatively impact health, leading to various complications and reduced life expectancy. In this study, we aim to estimate the prevalence of overweight and obesity and examine their association with diabetes, hypertension, and dyslipidemia. We also aim to determine the sociodemographic and clinical correlates of overweight and obesity, diabetes, hypertension, and dyslipidemia among adults in rural and urban areas of the Etawah district in Uttar Pradesh, India. Methods This cross-sectional study was conducted from January 2021 to June 2022. Study participants were selected using multistage random sampling. The study tool included a questionnaire based on the WHO STEPwise approach to NCD risk factor surveillance (STEPS). Descriptive analysis was performed using the Chi-square test and Student's unpaired t-test. Multivariate regression analysis was conducted to assess the strength of the association. Results The prevalence of overweight/obesity was almost similar in rural and urban areas. In rural populations, body mass index (BMI) showed a statistically significant association with diabetes status, hypertension status, systolic blood pressure, diastolic blood pressure (DBP), serum cholesterol, triglycerides, and very-low-density lipoprotein cholesterol. However, in urban populations, BMI was significantly associated only with diabetes status and DBP. Overweight was found to be more prevalent in upper socio-economic status residents (1.67 (0.93 - 2.98)), smokers (2.02 (1.19 - 3.41)), hypertensives (3.03 (1.34 - 6.85)), and participants with dyslipidemia (1.79 (1.13 - 2.83)). Conclusions The present investigation revealed a significant prevalence of overweight and obesity in the Etawah district, a critical risk factor for non-communicable illnesses in both urban and rural settings, necessitating a robust public health strategy.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86946"},"PeriodicalIF":1.0,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12206346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the Analgesic Effect of Adding Neostigmine to Lidocaine in Intravenous Regional Anesthesia for Carpal Tunnel Syndrome Surgery.","authors":"Jasim M Salman, Huda M Hadi","doi":"10.7759/cureus.87010","DOIUrl":"https://doi.org/10.7759/cureus.87010","url":null,"abstract":"<p><strong>Background: </strong>Neostigmine, a reversible acetylcholinesterase inhibitor (AChEI), has shown potential as an adjunct to local anesthetics like lidocaine in peripheral nerve blocks, including carpal tunnel syndrome (CTS). It may prolong analgesia by activating muscarinic receptors involved in pain modulation. Some studies report that adding neostigmine to lidocaine improves the duration of anesthesia and postoperative pain relief, particularly in upper limb procedures. However, results are mixed, possibly due to differences in doses or nerve barrier permeability. Overall, neostigmine's role in enhancing analgesia in nerve blocks such as Bier's block and CTS remains an active area of investigation.</p><p><strong>Aim of study: </strong>This study aims to assess the analgesic efficacy of adding 0.5 mg neostigmine to 2% lidocaine in adult patients undergoing upper limb surgery under intravenous regional anesthesia (IVRA). Specifically, it evaluates the impact of this combination on intraoperative and postoperative pain, analgesic requirements, and recovery profiles, thereby contributing to improved perioperative pain management strategies.</p><p><strong>Patients and methods: </strong>A total of 52 patients admitted to Al-Fayhaa Teaching Hospital, Basrah, Iraq, were randomized into two groups of 26 patients each. One patient excluded from analysis from each group. In the control group, local anesthesia of 3 mg/kg lidocaine was administered with 40 mL of normal saline. While the neostigmine group patients received 3 mg/kg lidocaine with 0.5 mg neostigmine, the same amount of saline was administered. Physiological parameters, sensation, and motor activity onset time, and recovery time after intravenous regional anesthesia were registered.</p><p><strong>Results: </strong>The neostigmine group included males (4%) and females (96%) with a mean age of 41.76±5.69 years, while the control group included males (20%) and females (80%) with a mean age of 37.6±5.00 years. There were no differences in the demographic data (American Society of Anesthesiologists (ASA), gender, weight), in addition to pinprick onset and recovery times, touch onset time, and block recovery time between both groups. A significant difference was observed in the age, surgical duration time, tourniquet time, touch recovery time, and motor block onset time between both groups (p < 0.05). In addition, no significant differences in postoperative complications were observed between the two groups (p = 0.074). However, there was a significant association in analgesic need, whether intraoperative or to reduce tourniquet pain, among the compared groups (p < 0.001).</p><p><strong>Conclusion: </strong>The addition of neostigmine to lidocaine in the surgical treatment of CTS shows no significant benefits regarding postoperative pain relief, but it is of benefit during the operation.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e87010"},"PeriodicalIF":1.0,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral Amyloid Angiopathy With Progressive Cortical Superficial Siderosis and Convexity Subarachnoid Hemorrhage in an Apolipoprotein E (APOE) ε2/ε2 Homozygous Patient: A Case Report and Literature Review.","authors":"Masahiro Hayashi, Mayumi Ikeda, Katsuji Kobayashi","doi":"10.7759/cureus.87007","DOIUrl":"https://doi.org/10.7759/cureus.87007","url":null,"abstract":"<p><p>Sporadic cerebral amyloid angiopathy (CAA) is characterized by progressive amyloid β-protein (Aβ) deposition in small cortical and leptomeningeal vessels. It is associated with intracerebral hemorrhage (ICH), cognitive decline, and gait disturbance. Among its hemorrhagic manifestations, cortical superficial siderosis (cSS) and convexity subarachnoid hemorrhage (cSAH) are gaining increasing attention, particularly in individuals carrying the apolipoprotein E (APOE) ε2 allele. A cSAH typically represents an acute-phase lesion caused by blood leakage into the subarachnoid space, often presenting as a single linear hypointensity on MRI. In contrast, cSS is a chronic-phase lesion characterized by hemosiderin deposition in the superficial cortex, typically appearing as a double-line hypointensity. Both lesions are believed to originate from the rupture or leakage of structurally fragile small vessels in the leptomeninges and superficial cortex. The accumulation of iron-containing blood products may trigger inflammatory responses and secondary damage to vessels and brain parenchyma, promoting recurrent hemorrhage and cognitive decline. The APOE ε2 allele is hypothesized to exacerbate vascular fragility through Aβ-mediated mechanisms and to increase the severity of hemorrhagic complications in CAA. Homozygosity for APOE ε2 is rare in the general population and has been associated with an elevated risk of hemorrhage in CAA, making this case particularly noteworthy. We report the case of a probable CAA in a man in his 60s who was homozygous for APOE ε2. Over a 10-month period, he experienced progression from mild cognitive impairment and subtle gait abnormality to severe dementia and marked limping. Imaging revealed recurrent cSAH and progressive cSS, along with simultaneous ICH and cSAH in opposite hemispheres. In particular, atypical cSAH-characterized by larger volume or prolonged blood retention-was followed by more extensive cSS in the same regions. Brain perfusion single-photon emission computed tomography (SPECT) showed hypoperfusion in cortical areas affected by these lesions, particularly in the bilateral frontal lobes, more pronounced on the left, and in the bilateral parietal lobes. This case highlights the aggressive course of CAA in a patient with APOE ε2/ε2 homozygote, where repeated hemorrhagic events and iron accumulation may result in both vascular injury and parenchymal dysfunction. We discuss imaging, clinical progression, and pathophysiological implications, with a focus on the role of APOE ε2 in exacerbating hemorrhagic lesions and promoting cognitive and motor decline.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e87007"},"PeriodicalIF":1.0,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Fatal Cascade Following Endoscopic Retrograde Cholangiopancreaticography (ERCP) Complicated by Pancreatitis, Duodenal Perforation, Gastrointestinal Hemorrhage, and Multi-organ Failure.","authors":"Sharath Rajagopalan, Vikash Kumar, Bharath P Bhushan, Leonard R Maier, Eric Huang","doi":"10.7759/cureus.86983","DOIUrl":"https://doi.org/10.7759/cureus.86983","url":null,"abstract":"<p><p>Endoscopic retrograde cholangiopancreatography (ERCP) is a valuable diagnostic and therapeutic procedure that carries inherent risks, with pancreatitis being a significant complication. While most cases resolve without major sequelae, severe complications can occur. A 65-year-old female with a history of pancreatitis developed post-ERCP pancreatitis following stent placement. The patient subsequently presented with walled-off fluid collections and experienced a catastrophic course complicated by duodenal perforation, severe hemorrhage, and multi-organ dysfunction, ultimately resulting in mortality. This case emphasizes the potential for life-threatening complications following post-ERCP pancreatitis and underscores the importance of vigilant monitoring and prompt intervention in managing these patients.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86983"},"PeriodicalIF":1.0,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12206490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Research Trends in Anticoagulation and Mechanical Thrombectomy for Iliofemoral Deep Vein Thrombosis: A Bibliometric Analysis (2000-2024).","authors":"Anas Alhur, Ghaidaa Abdulrahman S Alqahtani, Abdulelah Nasser S Alghaeb","doi":"10.7759/cureus.86924","DOIUrl":"https://doi.org/10.7759/cureus.86924","url":null,"abstract":"<p><p>This bibliometric study provides the first comprehensive analysis of global research trends, collaborative networks, and citation metrics related to anticoagulation and mechanical thrombectomy in iliofemoral deep vein thrombosis (DVT). Using Dimensions AI, 234 articles published between 2000 and 2025 were identified through a targeted search of terms including \"iliofemoral DVT,\" \"anticoagulation,\" and \"mechanical thrombectomy.\" Data extracted included publication year, citation count, research category, author affiliation, country of origin, and co-authorship. The study presents an overview of recent global research activity related to anticoagulation and mechanical thrombectomy in the context of iliofemoral deep vein thrombosis (DVT). It highlights key publication trends, leading contributors, and thematic focus areas within the literature. The analysis also outlines the collaborative nature of research efforts and shifts in scientific emphasis over time. Keyword trends indicated a shift from anticoagulation to mechanical thrombectomy as a research focus. Visual mapping using VOSviewer revealed strong institutional and international collaborations and distinct co-citation clusters. These findings highlight evolving priorities in iliofemoral DVT research and provide a foundation for future studies and collaborative efforts in vascular interventions.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86924"},"PeriodicalIF":1.0,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12205898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Unusual Cause of Knee Pain Identified by Point-of-Care Ultrasound in the Emergency Department.","authors":"Miguel F Agrait Gonzalez, Nehemesis Rivera Ortiz, Jenniffer Santiago, Glen Malaret Hernandez","doi":"10.7759/cureus.86934","DOIUrl":"https://doi.org/10.7759/cureus.86934","url":null,"abstract":"<p><p>Morel-Lavallée lesions (MLLs) are closed degloving injuries that typically result from shearing forces separating the subcutaneous tissue from the underlying fascia, creating a potential space that becomes filled with blood, lymphatic fluid, and necrotic tissue. These lesions are frequently missed on initial evaluation, especially in the context of blunt injury without obvious shearing trauma. Here, we present the case of a 28-year-old male who sustained trauma to his right thigh and knee while attempting to move a refrigerator. Initially diagnosed with a knee contusion after X-rays showed no fracture, the patient experienced worsening pain and swelling, prompting a visit to our emergency department (ED). Upon evaluation in the ED, the sonographic evaluation revealed a large fluid collection overlying the distal lateral thigh and lateral femoral condyle without any associated intraarticular effusion. Findings were consistent with an MLL, which was managed in the ED with ultrasound-guided drainage and compression therapy. This case highlights the importance of recognizing MLLs in the ED, as these injuries are frequently missed on initial evaluation. Early identification and appropriate management of MLL are crucial to preventing complications such as infection, chronic pain, loss of function, and delayed healing.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86934"},"PeriodicalIF":1.0,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12206076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vaccination Coverage and Associated Factors of Hepatitis B, Measles-Mumps-Rubella, Varicella, and Tetanus-Diphtheria-Acellular Pertussis Among Primary Health Care Workers in Qatar: A Retrospective Study (2020-2024).","authors":"Sameera Alhajri, Anees A Alyafei, Sandy Semaan, Maryam Al Muslemani, Asma Al Nuaimi","doi":"10.7759/cureus.86901","DOIUrl":"https://doi.org/10.7759/cureus.86901","url":null,"abstract":"<p><p>Background Healthcare workers (HCWs) are at an increased risk of exposure to infectious diseases, making vaccination a cornerstone of occupational health and patient safety. Despite clear recommendations, vaccination coverage among HCWs remains suboptimal worldwide, with significant disparities influenced by sociodemographic and professional factors. There is a lack of published data on vaccine uptake among HCWs in Qatar, particularly within the Primary Health Care Corporation (PHCC). This study aimed to assess the vaccination coverage rates for hepatitis B virus (HBV), measles, mumps, and rubella (MMR), varicella, and tetanus, diphtheria, and acellular pertussis (Tdap) among HCWs at PHCC in Qatar from 2020 to 2024 and to identify factors associated with vaccination status. Methods A quantitative, retrospective analysis was conducted using data from the Electronic Medical Records System and Human Resources Database across 31 PHCC health centers. All HCWs employed for at least three months were included. Sociodemographic and career-related variables were extracted. Vaccination status for HBV, MMR, varicella, and Tdap was determined. Descriptive statistics summarized coverage rates, and chi-square tests assessed the associations between vaccination status and sociodemographic variables. A p-value was considered statistically significant at <0.005. Results Among 7,463 PHCC employees, the mean age was 40.82 ± 9.00 years, with 65.06% females and 72.18% non-Qatari nationals. Clinical HCWs comprised 64.24% of the workforce. Vaccination coverage was 16.75% for HBV, 5.86% for MMR, 1.76% for varicella, and 12.87% for Tdap. Coverage rates were significantly higher among younger age groups, females, non-Qatari nationals, and those with fewer years of service (p < 0.001 for most comparisons). Non-clinical HCWs had higher HBV coverage, while clinical HCWs had higher Varicella coverage. Educational qualification was associated with HBV and MMR coverage but not with varicella or Tdap. Conclusions Vaccination coverage among PHCC HCWs in Qatar is considerably lower than international targets, with significant disparities across age, gender, nationality, job role, years of service, and education. These findings underscore the need for targeted interventions to enhance vaccine uptake and address barriers among specific HCW subgroups, thereby improving occupational and patient safety.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86901"},"PeriodicalIF":1.0,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12205483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unmasking Amoebiasis: An Unexpected Cause of Colitis in a Non-endemic Region.","authors":"Vikash S Sagar, Nauman Nauman, Gayathri Jayakumar, Bismah Kazi","doi":"10.7759/cureus.86877","DOIUrl":"https://doi.org/10.7759/cureus.86877","url":null,"abstract":"<p><p>Amoebic colitis is a common mimic of inflammatory bowel disease (IBD), primarily encountered in developing countries. We present a case of a 73-year-old British male with no travel history to any amoebic endemic regions, who presented with a three-month history of per rectal (PR) bleeding, diarrhoea, and a positive faecal immunochemical test (FIT). Prior to this, he reported no history of experiencing any gastrointestinal symptoms. Colonoscopy revealed patchy pan-colitis, most marked in the ascending colon, and histology confirmed chronic inflammation. A diagnosis of IBD was made, and the patient was started on corticosteroids and 5-aminosalicylates (5-ASA). He subsequently presented to the emergency department (ED) with worsening symptoms and rising inflammatory markers. Flexible sigmoidoscopy showed progression of inflammation, and despite treatment with intravenous corticosteroids and infliximab, a tumour necrosis factor-alpha (TNF-α) inhibitor, there was no improvement. Cross-sectional imaging performed due to new-onset breathlessness during this admission identified multiple hepatic abscesses and a superior mesenteric vein thrombus. Immunosuppression was stopped, and broad-spectrum antibiotics were initiated. Liver biopsy showed inflammatory cells, but no microorganisms were seen on cultures. Due to treatment-refractory colitis and contraindications to further immunosuppression, the patient underwent a laparoscopic subtotal colectomy with end ileostomy. Histology of the resected bowel was not in keeping with IBD, prompting re-evaluation of the initial biopsies taken from the colonoscopy at first presentation. On re-examination, amoebic-like trophozoites were seen, and the diagnosis of amoebic colitis was confirmed following review by a tertiary centre for specialist infectious disease and gastrointestinal pathology. This case highlights the need for a broad differential when managing treatment-refractory colitis, particularly in non-endemic regions, where the index of suspicion for amoebic colitis is low, and the risk of misdiagnosis is high.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e86877"},"PeriodicalIF":1.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}