Florias A Morfesis, MD, FACS1, Brian P Rose, PAS, MPH2. 1Owen Drive Surgical Clinic of Fayetteville, PLLC, 2Methodist University PA Program, Fayetteville, NC
Introduction: Spirochetes caused by Borrelia eurgyrata, Brachyspira aalborgi, and Serpulinaj pilosicoli, are known pathogens that infect the colon of humans resulting in watery diarrhea, abdominal pain, rectal bleeding and colonic distention. This case report describes the diagnosis and treatment of colonic spirochetosis in an HIV-positive male who presented with rectal bleeding and condyloma accuminata.
Case Report: A 46 year old black male presented to the general surgery clinic for evaluation of rectal bleeding and diarrhea. The patient’s past medical history is significant for human immunodeficiency virus positive (CD4 count 200), Hepatitis B, Hepatitis C, herpetic esophagitis, tobacco abuse, intravenous drug use, and hypertension. The patient sees his Infectious Disease provider regularly and is on Genvoya for his HIV disease. Physical exam was significant for occult blood and several perianal condylomas. The patient then underwent colonoscopy demonstrating colonic spirochetosis at the cecum on biopsy. The patient complete an extended course of Amoxicillin, Doxycycline, and Metronidazole. The patient reported resolution of his symptoms following the completed course of antibiotics at time of follow up.
Conclusion: Colonic spirochetosis can represent an incidental finding in most patients, but in the case of an immunocompromised patient, it presents a unique challenge. Spirochetosis prevalence varies from 2.5%-16% in developed nations. Other studies have reported its incidence as 5% among healthy patients and up to 30% among immunocompetent homosexual men. Oral-anal transmission has been suggested as a possible route of infection, but has not been definitively studied. This case study is unique in that the patient has significant proximal colon manifestation of spirochetosis with a low CD4 count. Treatment with Metronidazole has demonstrated good efficacy in the elimination of spirochetes. An addition of Amoxicillin and Doxycycline was added for gram negative and atypical coverage respectively. This case highlights a rare, but complicating intra-colonic infection that presents a unqiue challenge in the immunocompromised host.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77779
Program Number: P128
Presentation Session: Poster (Non CME)
Presentation Type: Poster
