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Letter to the Editor

Extract2=HeadB=Extract=HeadB Amoebic in Extract2=HeadA=Extract=HeadA Extract3=HeadA=Extract1=HeadA Crohn Disease Treated Extract3=HeadB=Extract1=HeadB With Ustekinumab BList1=SubBList1=BList1=SubBList BList1=SubBList3=BList1=SubBList2 Key Words: Crohn disease, ustekinumab, SubBList1=SubSubBList3=SubBList1=SubSubBList2 , liver abscess SubSubBList3=SubBList=SubSubBList=SubBList SubSubBList2=SubBList=SubSubBList=SubBList

SubBList2=BList=SubBList=BList To the Editors, Downloaded from https://academic.oup.com/ibdjournal/article/26/7/e68/5836916 by guest on 27 September 2021 Keywords=Keywords=Keywords_First=Keywords A male patient aged 50 years with HeadA=HeadB=HeadA=HeadB/HeadA Crohn disease (CD) who had been on a pre- HeadB=HeadC=HeadB=HeadC/HeadB vious working residency in Singapore was HeadC=HeadD=HeadC=HeadD/HeadC admitted with (103.1°F) and mild ab- Extract3=HeadA=Extract1=HeadA dominal pain. A year before, in Singapore, REV_HeadA=REV_HeadB=REV_HeadA=REV_HeadB/HeadA he had complained of spondyloarthritis FIGURE 1. Computed tomography scan of the liver with suspicion of liver abscess after REV_HeadB=REV_HeadC=REV_HeadB=REV_HeadC/HeadB and was treated with steroids and sub- initiation of ustekinumab treatment. REV_HeadC=REV_HeadD=REV_HeadC=REV_HeadD/HeadC sequently etanercept. After 4 months of The patient may have acquired amebi- patients with inflammatory bowel disease REV_Extract3=REV_HeadA=REV_Extract1=REV_HeadA therapy, he underwent appendectomy asis during his earlier stay in Southeast Asia on immunomodulatory therapies. BOR_HeadA=BOR_HeadB=BOR_HeadA=BOR_HeadB/HeadA for ruptured in California. as amebiasis is uncommon in California BOR_HeadB=BOR_HeadC=BOR_HeadB=BOR_HeadC/HeadB Because of ongoing abdominal pain and di- and Central Europe. Because amebiasis BOR_HeadC=BOR_HeadD=BOR_HeadC=BOR_HeadD/HeadC arrhea, a colonoscopy was performed a few Florian Rybinski, MSc,* can mimic CD, we reviewed all available † BOR_Extract3=BOR_HeadA=BOR_Extract1=BOR_HeadA weeks later, with endoscopic and histolog- Maja Weisser, MD, endoscopic biopsies and the appendectomy EDI_HeadA=EDI_HeadB=EDI_HeadA=EDI_HeadB/HeadA ical features characteristic of CD affecting Jan Hendrik Niess, MD,* and specimen for the presence of E. histolytica. EDI_HeadB=EDI_HeadC=EDI_HeadB=EDI_HeadC/HeadB the ascending colon and cecum. Therapy , We found the presence of E. histolytica in Petr Hruz, MD, PhD* EDI_HeadC=EDI_HeadD=EDI_HeadC=EDI_HeadD/HeadC was switched to adalimumab. Four months the appendectomy sample, suggesting that EDI_Extract3=EDI_HeadA=EDI_Extract1=EDI_HeadA later in Basel (Switzerland), as and From the *University Center for Gastrointestinal the patient had an amebic infestation while CORI_HeadA=CORI_HeadB=CORI_HeadA=CORI_HeadB/HeadA abdominal pain persisted, colonoscopy and Liver Diseases, Clarunis, St. Clara Hospital and taking immunosuppressive drugs (steroids University Hospital Basel, Switzerland; †Division CORI_HeadB=CORI_HeadC=CORI_HeadB=CORI_HeadC/HeadB was repeated, showing persistent segmental and tumor necrosis factor- blockers). The of Infectious Diseases & Hospital Epidemiology, CORI_HeadC=CORI_HeadD=CORI_HeadC=CORI_HeadD/HeadC right colonic and rectal . α University Hospital Basel, Basel, Switzerland close temporal relationship between the in- CORI_Extract3=CORI_HeadA=CORI_Extract1=CORI_HeadA Thereafter, therapy with ustekinumab was Author contributions: All authors have made sub- itiation of ustekinumab and the occurrence stantial contributions to all of the following: drafting ERR_HeadA=ERR_HeadB=ERR_HeadA=ERR_HeadB/HeadA initiated with 390 mg as a single infusion 8 of the amebic liver abscess suggested that the article, revising it critically for important intellec- ERR_HeadB=ERR_HeadC=ERR_HeadB=ERR_HeadC/HeadB weeks before admission. tual content, and final approval of the version to be the treatment with ustekinumab exacer- ERR_HeadC=ERR_HeadD=ERR_HeadC=ERR_HeadD/HeadC At admission initial laboratory submitted. bated amebiasis. Ustekinumab is an anti- Conflicts of interest: The authors have no financial ERR_Extract3=ERR_HeadA=ERR_Extract1=ERR_HeadA evaluation revealed a leukocytosis of relationships relevant to this article to disclose. 9 body binding to the p40 subunit shared by INRE_HeadA=INRE_HeadB=INRE_HeadA=INRE_HeadB/HeadA 15.2 × 10 /L and a C-reactive protein level interleukin-12 (IL-12) and IL-23. Blocking Address correspondence to: Petr Hruz, MD, PhD, INRE_HeadB=INRE_HeadC=INRE_HeadB=INRE_HeadC/ of 299 mg/L. A contrast-enhanced com- Clarunis, Petersgraben 4, 4031 Basel, Switzerland of the IL-12 pathway is associated with HeadB puted tomography showed a single large ([email protected]). reduced interferon-γ production and con- INRE_HeadC=INRE_HeadD=INRE_HeadC=INRE_HeadD/ liver mass (Fig. 1). Aspiration of the ab- sequently can increase susceptibility to in- HeadC scess revealed anchovy paste–like material. SUPPLEMENTARY DATA vasive amebiasis and liver abscesses.1-3 After INRE_Extract3=INRE_HeadA=INRE_Extract1=INRE_HeadA The polymerase chain reaction confirmed Supplementary data are available at successful treatment of amebiasis, the pa- SectionTitle=SectionTitle=SectionTitle=SectionTitle1 histolytica. Antibiotic therapy Inflammatory Bowel Diseases online. tient developed recurrence of abdominal App_Head=App_HeadA=App_Head=App_HeadA/ with and symptoms because of CD. Ustekinumab App_Head eliminated intrahepatic and possible REFERENCES had to be reinitiated, which successfully Affiliation=Abstract_aboverule=Affiliation=Affiliation extrahepatic E. histolytica. On abdominal 1. Nakada-Tsukui K, Nozaki T. Immune response resolved the CD flare within 10 days of amebiasis and immune evasion by Entamoeba Affiliation=Abstract=Affiliation=Affiliation ultrasound, resolution of the amebic liver histolytica. Front Immunol. 2016;7:175. (Supplementary Fig. S1). TableFooter1=TabTitle=TableFooter1=TableFooter abscess was observed on the follow-up visit. 2. Gazzinelli RT, Wysocka M, Hayashi S, et al. In summary, this case illustrates for Parasite-induced IL-12 stimulates early IFN- gamma synthesis and resistance during acute © 2020 Crohn’s & Foundation. the first time the occurrence of invasive infection with Toxoplasma gondii. J Immunol. Published by Oxford University Press. All infestation of amebiasis with liver abscess 1994;153:2533–2543. rights reserved. For permissions, please e-mail: 3. Lotter H, González-Roldán N, Lindner B, [email protected]. after initiation of ustekinumab treat- et al. Natural killer T cells activated by a ment for CD. It emphasizes continuous lipopeptidophosphoglycan from Entamoeba doi: 10.1093/ibd/izaa101 histolytica are critically important to control amebic Published online 14 May 2020 alertness for infectious complications in liver abscess. PLoS Pathog. 2009;5:e1000434.

Inflamm Bowel Dis • Volume 26, Number 7, July 2020 e68