Yan Chu, MD1, Anuj Chhaparia, MD2, Christine Boumitri, MD2 1St. Louis University, St. Louis, MO; 2St. Louis University Hospital, St. Louis, MO
Introduction: Intestinal spirochetosis, caused by gram-negative, motile spirochetes Brachyspira aalborgi and Brachyspira pilosicoli, is rare in developed countries. Reported cases of spirochetosis are predominantly in children and adults with HIV or men who have sex with men. We present a case of asymptomatic intestinal spirochetosis in an adult with chronic hepatitis C (HCV).
Case Description/Methods: A 66-year-old male with history of hypertension, inflammatory arthritis, compensated cirrhosis secondary to HCV, and colonic polyps presented for surveillance colonoscopy. He denied abdominal pain, diarrhea, or weight loss. He was HIV-negative and sexually active with one female partner. He had just completed a 12-week course treatment for HCV with Sofosbuvir/Velpatasvir and achieved sustained virologic response. Colonoscopy showed three 5-9 mm sessile polyps in cecum, one 4 mm sessile polyp in transverse colon (TC), and also one 2 mm white nodule in ascending colon (AC). The AC nodule and TC polyp biopsies showed a blurred “fuzzy” pale basophilic appearance along the surface epithelium, characteristic for spirochetosis. The same “fuzzy” surface was present on the tubular adenoma in the cecal polyps. Warthin-Starry stain revealed dense dark staining covering the surface epithelium and highlighting the spirochetes, confirming the hematoxylin and eosin (H&E) impression of spirochetosis. Patient was diagnosed with asymptomatic intestinal spirochetosis and referred to infectious diseases.
Discussion: This case presents a rare incidental finding of intestinal spirochetosis. Most adults, like our patient, are asymptomatic. Children and severely immunocompromised adults are more likely to have symptoms, which manifest as abdominal pain, diarrhea, and rectal bleeding. Diagnosis is challenging due to the lack of hallmark symptoms and nonspecific labs and endoscopic appearance. Intestinal spirochetosis is a histologic diagnosis, as colonoscopy commonly shows normal mucosa. Histologically, spirochetes coat the surface of colonic epithelium without eliciting mucosal injury or inflammation. Most cases are initially identified by routine H&E stain and confirmed with Warthin-Starry or Steiner silver stain. Our patient was asymptomatic and therefore did not require treatment. Symptomatic or immunocompromised patients may warrant treatment with Metronidazole or Clarithromycin, which in some cases lead to clinical improvement.
Figure: Endoscopic appearance of one 2 mm white nodule in the ascending colon
Disclosures: Yan Chu indicated no relevant financial relationships. Anuj Chhaparia indicated no relevant financial relationships. Christine Boumitri indicated no relevant financial relationships.
Yan Chu, MD1, Anuj Chhaparia, MD2, Christine Boumitri, MD2. P1271 - A Rare Case of Intestinal Spirochetosis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.