All are true about amoebic ulcer except

Refer Robbins page no Pg9/e 795 Amebic colitis is gradual in onset, with symptoms presenting over 1-2 weeks; this pattern distinguishes this condition from bacterial dysentery. Diarrhea is the most common symptom. Patients with amebic colitis typically present with cramping abdominal pain, watery or bloody diarrhea, and weight loss or anorexia. Fever is noted in 10-30% of patients. Intestinal amebiasis may mimic acute appendicitis. Rectal bleeding without diarrhea can occur, especially in children. Fulminant amebic colitis is a rare complication of amebic dysentery (< 0.5% of cases). It presents with the rapid onset of severe bloody diarrhea, severe abdominal pain, and evidence of peritonitis and fever. Predisposing factors for fulminant colitis include poor nutrition, pregnancy, coicosteroid use, and very young age (< 2 years). Intestinal perforation is common. Patients may develop toxic megacolon, which is typically associated with the use of coicosteroids. Moality from fulminant amebic colitis may exceed 40%.