Table 2

Rare extraintestinal manifestations of Entamoeba histolytica infection

Site	Risk	Clinical features	Prognosis
Pulmonary 130–133	Accounts for 2%–3% of extraintestinal manifestations More common when ALA, especially if ruptured Occurs by haematogenous or lymphatic spread	Cough ‘Anchovy paste’ sputum Haemoptysis Dyspnoea Pleuritic chest pain	Radiology may show elevated right hemidiaphragm and consolidation. Mortality of >16% Most respond rapidly to treatment as per ALA
Pericardial 134 135	Very rare More common when ALA in left hepatic lobe that ruptures	Chest pain Pericardial effusion Acute/constrictive pericarditis Cardiac tamponade Congestive cardiac failure	Left sided ALA drainage is recommended Pericardiocentesis is recommended
Neurological 136–138	Very rare Always concomitant ALA Brain abscesses may be single or multiple	Brain abscess Meningoencephalitis Headache Vomiting Impaired mental status Focal neurological signs	Fatal if not diagnosed early CT findings non-specific Longer treatment durations required, up to 8 weeks Surgical evacuation may be required
Cutaneous 30 139	Very rare May occur in isolation or with other organ Risk from poor perianal hygiene and sexual transmission	Painful perianal ulceration Single or multiple erythematous ulcers with well-demarcated elevated edges	Trophozoites may be isolated from ulcer exudate or by scraping ulcer edge Extensive spread may require reconstructive surgery
Genital 37 42 43 140–143	Very rare risk factor anal sex	Penile, vaginal and cervical ulcers Foul smelling vaginal discharge	Treatment as per other forms Trace and treat sexual partner

ALA, amoebic liver abscess.