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• W2913540107 abstract "Colonic spirochetosis is a condition characterized by invasion of spirochetal organisms, like brachyspira alborgi and brachyspira pilosicoli, into the colorectal epithelium. We present a case of chronic diarrhea that was eventually diagnosed as colonic spirochetosis and led to the diagnosis of HIV as well. 55 year old caucasian male with past medical history of hypertension, depression and psoriasis confined to his elbows presents to the clinic with intermittent diarrhea and associated abdominal discomfort for over one year. He has 3-4 non-bloody stools per day during an episode. He denied any fevers or weight loss. There was no significant travel history or exposure to pets or sick contacts. His family history was significant for colon cancer in his father at the age of 62. His first colonoscopy when he was 47 years old was benign. Another one from 3 years ago showed a benign distal transverse colon polyp. He has a 36 pack year smoking history but no alcohol or drug use. He is married but does not have kids. Physical exam was unremarkable. Routine stool studies including stool cultures, ova & parasites, fecal calprotectin and fecal leukocytes were all negative. CBC and CMP were unremarkable. He underwent colonoscopy which showed three colon polyps and diverticulosis of colon with possible segmental colitis. Biopsies revealed two hyperplastic polyps and one tubular adenoma. Random colon biopsy showed thickened brush border with filamentous bands. Hematoxylin-eosin staining revealed a diffuse blue fringe or “false brush border” and warthin-starry staining was used to confirm the diagnosis showing spirochetes. He was treated with flagyl for 10 days with reported improvement in diarrhea. He tested positive for HIV and was started on antiretroviral therapy. The clinical significance of colonic spirochetosis has been debated for many years in the literature. Although rare, homosexuals and HIV patients are at a higher risk of colonization and infection. Symptoms may be related to the extent of invasion beyond the epithelium and damage to the brush border. Although there is no classic endoscopic appearance, a potential association between colonic spirochetosis and hyperplastic and adenomatous polyps has been described in literature. Our case reflects the importance of considering intestinal spirochetosis as the cause of chronic diarrhea in cases with negative routine work up as well as checking their HIV status if spirochetosis is found.Figure: Random colon biopsy with H&E stain showing false brush border.Figure: Warthin Starry stain of colonic mucosa confirming spirochetes invading the epithelium." @default.
• W2913540107 created "2019-02-21" @default.
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• W2913540107 date "2017-10-01" @default.
• W2913540107 modified "2023-09-26" @default.
• W2913540107 title "Colonic Spirochetosis: A Rare Cause of Chronic Diarrhea" @default.
• W2913540107 doi "https://doi.org/10.14309/00000434-201710001-01414" @default.
• W2913540107 hasPublicationYear "2017" @default.
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