Researchers describe a patient with intestinal spirochetosis—a rare intestinal infection caused by Brachyspira aalborgi or Brachyspira pilosicoli that can involve the colon or terminal ileum and mimic inflammatory bowel diseases—in the May issue of Clinical Gastroenterology and Hepatology.
Manasi Agrawal et al report the case of a 45-year-old man with HIV infection and an undetectable viral load who was receiving antiretroviral therapy. He was evaluated for 1 month of constipation, abdominal pain, and intermittent rectal bleeding. He reported a transient rash, which resolved at presentation. Colonoscopy (see Figure A) revealed aphthous ulcers, friability, and exudates in the rectosigmoid colon and cecum with normal intervening colon and terminal ileum. Colonic biopsies (see Figure B) revealed long, undulating bacteria attached vertically to the brush border. These stained black with Warthin–Starry stain, indicating spirochetosis. The patient had a history of syphilis, exposure to Chlamydia, and a pet dog.
The patient was treated with oral 500 mg metronidazole, 4 times each day for 10 days, with complete resolution of symptoms.
Agarwal explain that the symptoms of intestinal spirochetosis usually include a transient rash, and that findings from colonoscopy can be normal. Risk factors include immune compromise (immunosuppression), a history of sexually transmitted diseases, men who have sex with men, and exposure to dogs. The disease can be treated with metronidazole (5–7 days).