Acute abdominal syndrome revealing an intestinal amoebiasis: Report of two cases in Tunisia

Amoebiasis is a parasitosis, mainly caused by Entamoeba histolytica (E. histolytica). It is a common disease in tropical and subtropical regions. E. histolytica possesses different mechanisms of pathogenicity, and might lead to the invasion and lysis of the intestinal epithelium. Outside of the high-risk regions, acute intestinal amoebiasis is a very rare condition, often leading to misdiagnosis and death, if not promptly treated. We discuss the cases of 18 and 43 year-old men without medical history, who presented to the emergency department complaining of acute abdominal pain along with fever. Following imaging features and clinical presentation, appendicitis and a complicated form of Crohn's disease were respectively suspected. Given the severity of the symptoms, an explorative laparotomy was performed showing in both cases an inflammatory aspect of the intestine. Histological examination concluded intestinal amoebiasis, a diagnosis that wasn’t suspected at first. The learning point of these cases is considering invasive intestinal amoebiasis in patients presenting with an acute abdominal syndrome, even with no history of traveling abroad or immunodeficiency.