An Unusual Cause of Abdominal Pain

Abstract

A 14-year-old girl patient presented with intermittent generalized abdominal pain. There was no history of diarrhea, constipation, gastrointestinal bleeding, weight loss, nausea, or vomiting. Routine laboratory tests, imaging studies, and stool studies were unremarkable. Upper and lower endoscopy was grossly normal. Random biopsies of the colon revealed a 2- to 3-μm-thick basophilic band along the surface epithelium of the colon (Fig. 1).FIGURE 1: Hematoxylin and eosin stain.The patient was diagnosed as having intestinal spirochetosis and treated with metronidazole. Intestinal spirochetosis is rare in children with an increased prevalence in immunosuppressed patients and homosexual males (1,2). Spirochetes can cause abdominal pain, chronic diarrhea, hematochezia, and appendicitis in some cases (3,4). The majority of patients are asymptomatic with incidental findings of spirochetes on colonic biopsies (3–5). Histology is characterized by a densely packed brush border of spirochetes Brachyspira aalborgi and Brachyspira pilosicoli attached to the epithelial surface of the colon that can be stained with H and E or silver stains (Fig. 2) (6). Clinical significance remains elusive with treatment of incidental findings debatable. Antimicrobial agents such as metronidazole and macrolides have been associated with resolution of symptoms and eradication of the intestinal spirochetes in adults (1,3). There are no standard therapies in pediatric patients (1). Thus, large population-based studies are required to analyze the demographics, clinical significance, and therapeutic outcomes of intestinal spirochetosis in children.FIGURE 2: Steiner stain.