Ulcerative Proctitis: An Unusual Case of Intestinal Spirochetosis

Human intestinal spirochetosis (HIS) is an uncommon disease characterized by the colonization of spirochetes in the colorectal mucosa and is most often found in individuals who are positive for human immunodeficiency virus (HIV) and in homosexual men. Although HIV is known to cause a variety of infe...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2022-12, Vol.14 (12), p.e33046
Main Authors: Baum, Jeffrey, Won, Jung, Fenster, Moshe, Correa, Joseph, Bansal, Raghav
Format: Article
Language:English
Subjects:
Abdomen
Abscesses
Antiretroviral drugs
Asymptomatic
Biopsy
Case reports
Colon
Colonoscopy
Cytomegalovirus
Diarrhea
Gastroenterology
HIV
HIV/AIDS
Human immunodeficiency virus
Immune system
Infectious Disease
Inflammatory bowel disease
Internal medicine
Laboratories
Rectum
Small intestine
Soil erosion
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Summary:Human intestinal spirochetosis (HIS) is an uncommon disease characterized by the colonization of spirochetes in the colorectal mucosa and is most often found in individuals who are positive for human immunodeficiency virus (HIV) and in homosexual men. Although HIV is known to cause a variety of infectious colitis, the prevalence has significantly declined with antiretroviral therapy. Intestinal spirochetosis, however, remains meaningful as it can be an infectious cause of colonic ulcerations even with well-controlled HIV. Spirochetosis rarely causes macroscopic changes in the colorectal mucosa and reports of an ulcerated rectum are exceedingly scarce. Here, we report a case of a homosexual man with HIV who is compliant with antiretroviral therapy with high CD4 counts who presented with a six-week history of bloody diarrhea and was found to have multiple ulcerations in the rectosigmoid junction and rectum infected with non-treponemal spirochetes as confirmed on biopsy. To our knowledge, there have not been any reports of multiple rectal ulcerations caused by non-treponemal spirochetes. The patient was treated with metronidazole 500 mg four times daily for 10 days with complete resolution of symptoms. This case is notable as it alerts clinicians to consider intestinal spirochetosis as a differential diagnosis in the workup for bloody stool in the presence of colorectal ulcerations.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.33046