Orlando A. Rodriguez Amador, MD, Zeyn Mirza, MD, Jose Martin-Ortiz, MD, FACG VA Caribbean Health Care System, San Juan, Puerto Rico
Introduction: Intestinal spirochetosis, first described in 1967, is an uncommon disease defined by colonization of the colonic epithelial cell with anaerobic spirochetes of the Brachyspiraceace family. Histologically, it is characterized by a distinctive fringe-like, end on end attachment of a densely packed filamentous spirochetes on the surface of the epithelium of the colon. Its prevalence varies depending on geographic location, but ranges between 2%-7% in Western countries. Higher prevalence has been noted in homosexual men and HIV-positive patients. Patient may present asymptomatically or with associated symptoms. Most cases are found incidentally during screening or surveillance colonoscopy. Here we present a patient with evidence of spirochetosis after a screening colonoscopy.
Case Description/Methods: A 71 y/o male patient with history of prostate adenocarcinoma and squamous cell carcinoma of lung s/p lobectomy in 2020 on home oxygen who was consulted to gastroenterology services for screening colonoscopy. Last colonoscopy on 2010 revealed severe diverticulosis, hemorrhoids and no evidence of masses or polyps. He denied episodes of rectal bleeding, stool changes or unintentional weight loss. Patient underwent colonoscopy with evidence of 2 diminutive sessile polyp at transverse colon and pandiverticulosis. Pathology showed finding remarkable for tubular adenoma and fragment of colonic mucosa with a blue fringe over the surface epithelium suggestive of spirochetosis. Due to finding, infectious diseases services were consulted and stated that the found organism was most likely to be Brachyspira aalborgi or pilosicoli. Since he was asymptomatic and immunocompetent, with negative HIV test, recommendations were to not start antibiotic therapy and to be monitored clinically. Since he continued clinically stable without symptoms there was no need for starting therapy.
Discussion: Intestinal spirochetosis is a disease mostly found accidentally during surveillance and screening colonoscopy when biopsies are taken from polyps or diverticula. Generally, infection is non-invasive, but rarely invasion occurs causing diarrhea, abdominal pain or bleeding. There are reports of more severe disease and increasing incidence in the homosexuals and HIV positive population. When symptomatic, treatment consists of metronidazole. The importance of this case is to make the practicing physician aware of this rare disease, its clinical presentation, management and the growing in incidence in the aforementioned population.
Disclosures:
Orlando Rodriguez Amador indicated no relevant financial relationships.
Zeyn Mirza indicated no relevant financial relationships.
Jose Martin-Ortiz indicated no relevant financial relationships.
Orlando A. Rodriguez Amador, MD, Zeyn Mirza, MD, Jose Martin-Ortiz, MD, FACG. C0140 - To Treat or Not to Treat: A Case of Intestinal Spirochetosis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.
