Severe Human Intestinal Spirochetosis: An Unusual Cause of Diffuse Colonic Ulcerations in a Patient Living With HIV

Abstract

We describe a case of a homosexual male with human immunode ciency virus (HIV) and CD4 count of 246 presenting with acute severe bloody diarrhea. Infectious work up was negative, and colonoscopy revealed severe di use colonic ulcerations. Histopathologic analysis and Treponemal pallidum immunostaining con rmed the diagnosis of intestinal spirochetosis. ere was no evidence of co-infection with other pathogens. His symptoms completely resolved a er a 14-day course of metronidazole. is case is notable as colonic ulceration of any severity in patients living with HIV is rarely identi ed with intestinal spirochetosis. Hence, it should be considered in the di erential diagnosis of colonic ulcerations.