Fulminant amebic colitis complicated by appendiceal perforation and massive abdominal hemorrhage: a case report and literature review

Introduction Fulminant amebic colitis complicated by intestinal perforation or massive intra-abdominal hemorrhage is uncommon but associated with extremely high mortality. In non-endemic regions, diagnosis is frequently delayed because early manifestations resemble bacterial appendicitis or perforated peritonitis. Case presentation We report a fatal case of Entamoeba histolytica infection presenting with appendiceal perforation, septic shock, and recurrent intra-abdominal bleeding. Surgery revealed extensive transmural necrosis, deep ulcers, and exposure of submucosal vessels. Metagenomic next-generation sequencing (mNGS) of blood and peritoneal drainage fluid was performed, followed by histopathological confirmation. Despite emergent appendectomy, bowel resection, and prompt initiation of anti-amebic therapy, the patient developed refractory septic shock and recurrent intra-abdominal hemorrhage, resulting in death. Conclusion mNGS can facilitate early recognition of severe amebiasis when conventional diagnostic modalities are uncertain, particularly in non-endemic settings. Fulminant amebic colitis complicated by perforation or hemorrhage carries a poor prognosis. Timely clinical suspicion and early anti-amebic therapy are essential to improve outcomes.