A Case of Intestinal Spirochaetosis with Weight Loss and Diarrhea Treated with Metronidazole

Abstract

A 34-year-old man with no significant medical history was seen at our outpatient department with a three-month history of weight loss, diarrhea and fatigue. Colonoscopy was performed, showing red and edematous mucosa in the ileocecal valve. A biopsy specimen with hematoxylin and eosin staining revealed basophilic and flocculent colonies that adhered to the surface epithelium. The organisms were dyed black by Warthin-Starry staining. These findings were compatible with intestinal spirochaetosis. We ruled out any other disease through biochemical examination of blood, esophagogastroduodenoscopy, capsule endoscopy,computed tomography and stool culture and diagnosed intestinal spirochaetosis. The patient improved after treatment with 1500mg/day of Metronidazole for 7 days. Colonoscopy was performed again after 8 months. The mucosa in the ileocecal valve was normal, and a biopsy specimen showed the spirochaetal infection had disappeared. Case reports of intestinal spirochaetosis are rare due to the low level of awareness of the disease. The present case suggests that we have to rule out intestinal spirochaetosis as a cause of chronic diarrhea.