Refractory inflammatory bowel disease – Entamoeba histolytica, the forgotten suspect

•History of ‘dysenteric illness’ in MSM in absence of a travel history is enough to instigate investigations.•IFAT titre > 320 is usually predictive of active disease.•Amoebic colitis can be misdiagnosed as IBD and immunosuppression can cause perforation.•Where risk factors exist, repeat diagnostic samples should be sent including colonic biopsies.•Treatment with metronidazole and paromomycin is highly effective.