This document presents a case study of a 50-year-old female patient who presented with loose stools for 2 days. Her condition did not improve with initial treatment and her diarrhea increased to 20-30 episodes per day. Laboratory tests found Entamoeba histolytica cysts in her stool. Despite treatment with antibiotics, antiamoebic medications, and loperamide, her condition continued to worsen with increased diarrhea episodes. A CT scan showed a simple liver cyst but no other abnormalities. The case is presented for discussion as the patient's condition has not responded to treatment.

1. CLINICO PATHOLOGICAL CASE
PRESENTATION
GM 2

2. PATIENT DETAILS
• NAME : X
• AGE : 50 YEARS
• SEX : FEMALE

3. CHIEF COMPLAINT
• Loose stools x 2 days

4. HISTORY OF PRESENT ILLNESS
Patient was apparently normal before 2 days and
developed diarrhoea which was
 Watery,
15-20 episodes/ day
Not Blood Stained,
No mucus
Not Foul Smelling And Large In Amount.
Complaints Of Fatiguability.
Complaints Of Nausea.

5. • No complaints of fever
• No complaints of chest pain/ palpitation
• No complaints of breathlessness
• No complaints of cough with expectoration
• No complaints of abdominal pain
• No complaints of vomiting
• No complaints of burning micturition.

6. PAST HISTORY
• No history of similar complaints in the past.
• History of abdominal surgery done 20 years
back(details not available) done in Jipmer.
• Not a known case of T2DM/ SHTN/
BA/epilepsy/CAD/TB/CKD/thyroid disorders.

7. Personal history
• Consumes mixed diet
• Normal bladder habits.
• No consumption of alcohol and tobacco in
any form.
• FAMILY HISTORY
Nil relevant

8. MEDICATION HISTORY
• No history of previous medications
• MENSTRUAL HISTORY:
Post menopausal status attained 2 years back.

9. GENERAL EXAMINATION
• O/E Patient conscious oriented afebrile
• Mild pallor
• Dehydration +
• No icterus
• No cyanosis
• No clubbing
• No lymphadenopathy
• No edema

10. VITALS
• BP – 110 / 70
• PR – 80 / min
• RR - 12 / MIN
• SPO2 – 98% IN RA
• GCS – 15 / 15
• CBG – 120 mg / dl

11. Systemic examination
• CVS : S1 S2 + No murmur
• RS : NVBS+ B/L AE+ No added sounds
• P/A : Soft , BS +
a mid line laparotomy – healed , healthy
non tender,
no organomegaly
• CNS : Able to move all four limbs
Power 5/5 in all 4 limbs
B/L plantar- flexor

12. Investigations
TOTAL COUNT 12200 cells/cumm
NEUTROPHILS 88.6%
LYMPHOCYTES 7.7%
EOSINOPHILS 0.9%
BASOPHILS 0.1%
MONOCYTES 2.7%
BAND CELLS 0%
RBC 4.08cells/cumm
PCV 34.9%
MCV 86.0fl
MCH 26.0pg
MCHC 30.3%
PLATELET 368000 lakhs/ cumm
HAEMOGLOBIN 10.6 g/dl

13. Sodium 138mEq/l
Potassium 4.6mEq/l
Chloride 112mEq/l
Urea 31mg/dl
creatinine 0.82mg/dl

14. • URINE ROUTINE
URINE REACTION ACIDIC
PH 6.0
ALBUMIN NIL
SUGAR NIL
MICROSCOPY
PUS CELLS 2-4
EPITHELIAL CELLS 2-3
RBC NIL
CASTS NIL
CRYSTALS AND BACTERIA NIL

15. LFT
TOTAL PROTEIN 5.7g/dl
ALBUMIN 3.9g/dl
GLOBULIN 1.8g/dl
A/G RATIO 2.2:1
TOTAL BILIRUBIN 0.5mg/dl
DIRECT BILIRUBIN 0.2mg/dl
SGOT 30U/L
SGPT 25U/L
ALP 68U/L
ESR ½ HR 8mm/hr
ESR 1 HR 18mm/hr

16. serology
• HIV-non reactive
• HCV- non reactive
• Hbsag- non reactive
• THYROID PROFILE
• T3-2.51Pg/ml
• T4-1.09ng/dl
• TSH-3.20IU/ml

17. STOOL EXAMINATION
• POSITIVE FOR CYSTS OF ENTAMOEBA
HISTOLYTICA
• STOOL CULTURE : STERILE
• HANGING DROP : NEG

18. • USG ABDOMEN : NO SIGNIFICANT
ABNORMALINTY

19. INITIAL TREATMENT
• IV FLUIDS – NS @ 150 ml / hr
• T.CLOX TZ PO 1-0-1
• C. BIFILAC PO 1-1-1
• ORS SACHET 200 ml after each stool

20. • Even after initial treatment patient condition
did not improved and the frequency of
diarrhoea increased( 20 – 30 episodes / day )
and needed nearly around 10 lit of fluids /
day.

21. TREATMENT
1) INJ. CIPRO 200MG IV 1-0-1
2) INJ. METRO 500MG IV 1-1-1
3) T. LOPERAMIDE 2MG 1-1-1
4)C.BIFILAC 2-2-2
5) T.RIFAGUT 400 MG 1-0-1

22. CECT ABDOMEN
• Simple liver cyst
• Other visualised organs normal.

23. • Patient general condition worsened further ,
patient frequency of diarrhoea also increased.

24. • Case open for discussion.