SPIROCHETE-INDUCED COLITIS BY BRACHYSPIRA SPECIES ASSOCIATED WITH CHLAMYDIA MIMICKING CROHN'S DISEASE: CASE REPORT

Case Presentation We report the case of a 28-year-old man who has sex with men (MSM), with no prior history of immunodeficiency, presenting to the clinic with complaints of diarrhea with muco-bloody discharge, rectal pain, weight loss, and anorexia. Proctological examination revealed a posterior midline anal fissure with a sentinel skin tag and distal proctitis but no purulent exudate. Given the clinical picture, laboratory and serological tests for sexually transmitted infections (STIs) were requested, revealing positivity only for Chlamydia. However, due to the patient’s age, diarrhea, and general symptoms, endoscopic examinations were also conducted to complement the investigation. Although the initial findings from the colonoscopy supported the suspicion of inflammatory bowel disease (Crohn's Disease), the histopathological study revealed colonization of the intestinal mucosa by spirochetes of the Brachyspira genus. The patient was treated with doxycycline for 21 days, resulting in the complete resolution of intestinal complaints and general symptoms.

Discussion Intestinal spirochetosis, though rare, is a disease that can mimic inflammatory bowel disease. Its diagnosis is confirmed through histopathological examination, and treatment is based on the use of antibiotics. The individuals at higher risk are immunosuppressed patients and MSM; however, it can also occur in patients without immunosuppression. Furthermore, it may be associated with another infectious agent, as demonstrated in this case, where it was linked to Chlamydia.

Conclusion In patients, particularly MSM, presenting with diarrhea and associated general symptoms, intestinal spirochetosis should be considered as a differential diagnosis, even in the absence of immunodeficiency. It may coexist with other infectious agents that also cause intestinal symptoms, such as Chlamydia.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025