716 - A Case of Symptomatic Intestinal Spirochetosis

Background: Intestinal spirochetosis (IS) is a condition caused by Brachyspira aalborgi and Brachyspira Pilosicoli. Its clinical significance has long been a point of contention with some debating that these spirochetes are simply colonic commensals. It is a condition that is more prevalent in developing nations as well as patients with HIV and the homosexual population. The epidemiology and prevalence of IS has not been studied in the local context.

Methods: We reviewed a case of a 37-year-old man who presented with a two month history of persistent lower abdominal pain, hematochezia, and increase in mucous discharge per rectum. He is sexually active with multiple male partners, and was previously treated for gonorrhea, chlamydia, and syphilis. His basic laboratory investigations were unremarkable, Venereal Disease Research Laboratory (VDRL)  antibody and human immunodeficiency virus (HIV) screen were both non-reactive. Computed tomography of the abdomen was unremarkable. Endoscopic evaluation revealed multiple discrete ulcers measuring 1-2mm seen only in the rectum. Random biopsies of the cecum, ascending colon, transverse colon and descending colon showed mild acute colitis with IS. There was also mild to moderate acute proctitis in the rectum with spirochetes seen. 16s RNA gene sequencing of the biopsy specimen were confirmatory for Brachyspira aalborgi.Investigation findings. A: Discrete Ulcers found in rectum, B: Hemotoxylin and Eosin stained specimen showing proctitis, C: False brush Border appearance D: Spirochetes on Warthin Starry stain


Results: The patient received a 10 day course of metronidazole with complete resolution of his symptoms.

Conclusion: This case demonstrates the existence of a treatable condition that can be diagnosed with current available investigations for patients with similar symptoms. Recognising at risk populations can also raise clinical suspicion for this condition. Some studies have found associations between IS with development of colonic polyps and also certain colorectal cancers. Further studies on this treatable condition and its disease burden in the local context should be further explored.