Novotny S, Mizrahi J, Yee EU, Clores MJ. Incidental diagnosis of intestinal spirochetosis in a patient with chronic hepatitis B: A case report. World J Clin Infect Dis 2022; 12(2): 69-75 [DOI: 10.5495/wjcid.v12.i2.69]
Corresponding Author of This Article
Samantha Novotny, BSc, Research Assistant, Renaissance School of Medicine, Stony Brook University, 101 Nicolls Road, Stony Brook, NY 11794, United States. samantha.novotny@stonybrookmedicine.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Infect Dis. Sep 29, 2022; 12(2): 69-75 Published online Sep 29, 2022. doi: 10.5495/wjcid.v12.i2.69
Incidental diagnosis of intestinal spirochetosis in a patient with chronic hepatitis B: A case report
Samantha Novotny, Joseph Mizrahi, Eric U Yee, Michael J Clores
Samantha Novotny, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, United States
Joseph Mizrahi, Michael J Clores, Division of Gastroenterology and Hepatology, Stony Brook Medicine, Stony Brook, NY 11794, United States
Eric U Yee, Department of Pathology, Stony Brook Medicine, Stony Brook, NY 11794, United States
Author contributions: Mizrahi J and Clores M performed conceptualization; Mizrahi J, Yee EU, and Clores M performed patient care; Novotny S performed literature review; Novotny S, Mizrahi J, and Yee EU wrote the original manuscript draft; Novotny S, Mizrahi J, Yee EU, and Clores M performed review and editing of the manuscript; Mizrahi J and Clores M performed supervision of the manuscript; All authors have read and agreed to this version of the manuscript.
Informed consent statement: Informed consent for publication of this report and images was obtained from the patient.
Conflict-of-interest statement: Yee E consults for PathAI, Boston, MA. Novotny S, Mizrahi J, and Clores M declare no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Samantha Novotny, BSc, Research Assistant, Renaissance School of Medicine, Stony Brook University, 101 Nicolls Road, Stony Brook, NY 11794, United States. samantha.novotny@stonybrookmedicine.edu
Received: April 22, 2022 Peer-review started: April 22, 2022 First decision: June 16, 2022 Revised: July 1, 2022 Accepted: August 22, 2022 Article in press: August 22, 2022 Published online: September 29, 2022 Processing time: 156 Days and 20.6 Hours
Abstract
BACKGROUND
Intestinal spirochetosis (IS) is caused by Brachyspira colonization of the gastrointestinal tract. Some patients are asymptomatic, while others present with gastrointestinal complaints such as abdominal pain, diarrhea, or gastrointestinal bleeding. However, the clinical significance of asymptomatic IS is unclear, and guidelines are lacking regarding decision to treat.
CASE SUMMARY
A 73-year-old male with peptic ulcer disease and gastroesophageal reflux was evaluated for elevated liver enzymes. He was diagnosed with chronic hepatitis B virus and prescribed entecavir. Additionally, he was leukopenic and had stage 4 liver fibrosis on transient elastography. After 5 mo, the patient returned for esophagogastroduodenoscopy and screening colonoscopy. He denied any gastrointestinal symptoms at that time. Findings included grade I distal esophageal varices, mild portal hypertensive gastropathy, and patchy nodular gastric antral mucosa. On colonoscopy, several polyps were removed. Hematoxylin and eosin stain of mucosa adjacent to the polyps revealed a “false brush border,” and Steiner stain identified spirochetes adherent to the mucosa. These pathology findings confirmed the diagnosis of IS. He was managed conservatively with careful observation and without antibiotic therapy via a multidisciplinary approach between gastroenterology and infectious disease. He remained asymptomatic at the 7-wk follow-up.
CONCLUSION
This case reports the finding of incidental, asymptomatic IS in a leukopenic patient with hepatitis B virus. Conservative management was appropriate.
Core Tip: Intestinal spirochetosis is caused by Brachyspira colonization of the gastrointestinal tract. Some patients are asymptomatic, while others present with gastrointestinal complaints such as abdominal pain, diarrhea, or gastrointestinal bleeding. However, the clinical significance of asymptomatic intestinal spirochetosis is unclear, and guidelines are lacking regarding decision to treat. We report the case of an asymptomatic 73-year-old male with chronic hepatitis B and leukopenia who was incidentally diagnosed with intestinal spirochetosis on pathology of polyps resected during routine screening colonoscopy. He was managed conservatively with careful observation and without antibiotic therapy via a multidisciplinary approach between gastroenterology and infectious disease.
