Intestinal spirochetosis -A mystical entity- A tale of two pediatric cases

Intestinal spirochetosis (IS) is an uncommon infection in pediatric population. It is often found in immunocompromised or homosexual adult individuals. It can mimic inflammatory bowel disease (IBD) in immunocompetent pediatric population with similar presentation of abdominal pain, rectal bleeding and bloody diarrhea. The diagnosis of IS requires careful histopathological examination and a few simple special stains can confirm the diagnosis. A literature review of the past 21 years yielded only 32 cases of IS in the pediatric population. We hereby report two cases in IS in immunocompetent children, one having coinfection with amoebiasis. A rarity in the pediatric age group and lack of awareness raises the suspicion of its under-recognition in routine histopathologic examination. This report emphasizes the importance of meticulous and thorough histopathological examination of pediatric colonic biopsies for the diagnosis of intestinal spirochetosis as it is a curable and treatment-responsive disease.