Intestinal spirochetosis: a poorly understood infection causing chronic diarrhea

A young man with chronic diarrhea for many years underwent extensive evaluation. Finally, based on multiple colonic mucosal biopsies from near-normal appearing mucosa, the cause was elucidated to be spirochetosis. This is an enigmatic condition where the spirochetes seem to attach to the epithelial lining of the small and large bowel, without significant underlying inflammation. Because of this reason, there is controversy whether it is a true diarrheal pathogen. Suggested treatments are discussed.