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Human intestinal spirochetosis mimicking ulcerative colitis
Shin Nishii1, Masaaki Higashiyama2, Sho Ogata3
1Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan.
Clinical Journal of Gastroenterology
|December 6, 2017
Summary
Human intestinal spirochetosis (HIS) may cause colorectal inflammation, mimicking ulcerative colitis (UC). Early antibiotic treatment is crucial for HIS, especially with atypical UC symptoms.
Area of Science:
- Gastroenterology
- Infectious Diseases
Background:
- Human intestinal spirochetosis (HIS) is a colorectal infection by Brachyspira species, with unclear pathogenicity due to mild symptoms.
- Ulcerative colitis (UC) is a chronic inflammatory bowel disease requiring accurate diagnosis and management.
Observation:
- A case of HIS co-occurring with suspected "right-sided" UC was monitored over five years.
- Colonoscopy revealed erosive colitis and HIS, resembling UC skip lesions.
- The patient developed bloody diarrhea, unresponsive to initial observation.
Findings:
- Metronidazole treatment improved HIS-related symptoms and colonoscopic/histopathological findings.
- HIS was implicated as the cause of colorectal inflammation in this case.
- HIS diagnosis is challenging in chronic proctocolitis and can mimic UC.
Implications:
- HIS may play a pro-inflammatory role in the colon.
- HIS should be considered in the differential diagnosis of UC, particularly atypical presentations.
- Prompt antibiotic administration is recommended upon HIS detection to manage associated inflammation.
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