Intestinal Spirochetosis in an Immunocompetent Patient.

Patricia Guzman Rojas,Glenn Speth,Jelena Catania,Tran C Phung,Jignesh Parikh

doi:10.7759/cureus.2328

Patricia Guzman Rojas, Glenn Speth + Show 3 more

Open Access

https://doi.org/10.7759/cureus.2328

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Journal: Cureus	Publication Date: Mar 15, 2018
Citations: 10	License type: cc-by

Affiliation: Orlando VA Medical Center

Abstract

Intestinal spirochetosis (IS) is an infestation defined by the presence of spirochetes on the surface of the colonic mucosa. The implicated organisms can be Brachyspira aalborgior Brachyspira pilosicoli.We present the case of a 66-year-old man with a past medical history of diabetes mellitus, hypertension, morbid obesity, and gastroesophageal reflux. The patient was sent to the gastroenterology clinic for a screening colonoscopy due to a prior history of colonic polyps. The patient was completely asymptomatic as he denies any abdominal pain, diarrhea, melena, or hematochezia. A colonoscopy was done showing colitis in the cecum and at the ileocecal valve, for which random biopsies were taken in the terminal ileum, cecum, and ascending colon. The histopathology result was positive for spirochetosis. Due to this finding, the patient was referred to the infectious diseases clinic, where a rapid plasma reagin (RPR) and human immunodeficiency virus (HIV) tests were found to be negative. Since the patient was immunocompetent and asymptomatic, it was decided to monitor and not initiate antibiotic treatment.Human IS are not related to non-intestinal spirochetes like Treponema pallidum. An infection of T. pallidum leads to a malignant picture called syphilitic proctitis and appears in the setting of an immunocompromised patient. The treatment of IS is based on the clinical presentation, severity of symptoms, and immune status. The purpose of this case is to emphasize the correct antibiotic indication in patients with IS.

Highlights

Intestinal spirochetosis (IS) is the presence of spirochetes on the surface of the intestinal mucosa and was first described in 1967 [1]
Intestinal spirochetosis (IS) is an infestation defined by the presence of spirochetes on the surface of the colonic mucosa
We present the case of a 66-year-old man with a past medical history of diabetes mellitus, hypertension, morbid obesity, and gastroesophageal reflux

Summary

Introduction

Intestinal spirochetosis (IS) is the presence of spirochetes on the surface of the intestinal mucosa and was first described in 1967 [1]. We present the case of a 66-year-old man with a past medical history of diabetes mellitus, hypertension, morbid obesity, and gastroesophageal reflux disease He was sent to the gastroenterology clinic for a screening colonoscopy due to a personal history of polyps and mild anemia (hemoglobin of 12.6 mg/dL). The biopsy from the cecum was positive for mild chronic nonspecific inflammation and Warthin-Starry stain was positive for spirochetosis (Figure 2). The patient was referred to the infectious diseases (ID) clinic where rapid plasma reagin (RPR) and human immunodeficiency virus (HIV) tests were ordered. A Warthin-Starry silver stain highlighted filamentous organisms (Figure B)

Discussion

Findings

Disclosures