1562 Rare Intestinal Spirochetosis Masquerading as a Colonic Polyp

Abstract

INTRODUCTION: Spirochetosis in colonic mucosa is exceedingly rare in non-immunocompromised individuals. There have been less than 200 cases documented and more rare with the specific B. Pilosicoli genus. Spirochetosis is also seen in individuals who engage in high risk sexual encounters. This type of spirochetosis is found mosty in dogs, cats, pigs and chickens. Symptoms in humans include diarrhea, rectal bleeding, and abdominal cramps. Colonic spirochetosis is more common in third world countries. Even in immunocompromised state of health and with all other factors there is much unknown about colonic spirochetosis. Due to its infrequency the treatment is metronidazole and repeat colonoscopy and biopsy should symptoms persist. CASE DESCRIPTION/METHODS: Patient is a 62 year old male patient who presented as an outpatient consultation for screening colonoscopy. The patient complains of abdominal pain for several months that is localized in the right upper quadrant. The patient describes the pain as moderate to sharp and only last a few minutes after onset. Patient also reported post prandial fullness, abdominal bloating and distention. The patient denied rectal bleeding, melena, constipation, or pain on evacuation. The patient denies other symptoms. The patient has no medical history and only surgery was an elective laparoscopic cholecystectomy. The Decision was made to undergo screening colonoscopy. The patient had no history of immunocompromised state or HIV/AIDS. The patient denies anal sex. Colonoscopy revealed he had two polyps. One in the ascending colon and the other in the rectum. The specimens were sent for pathology for analysis. Ascending polyp was analyzed and it demonstrated colonic mucosa consistent with intestinal spirochetosis specifically Brachyspira pilosicoli. The rectal polyp was hyperplastic no adenomatous change. DISCUSSION: This case was chosen because only 200 known cases of colonic mucosa infected with spirochetosis have been documented. The patient is not immunocompromised, does not engage in anal sex, is not in a third world country, and does not have typical symptomatology of infection with Spirochetosis. In general colonic involvement with spirochetosis is very misunderstood due to its infrequency. The genus of B.pilosicoli. Is a spirochete genus that has limited data on how many cases have been documented. The presentation as a colonic polyp as a masquerade for actice spirochetosis infection prompts further study.