INTESTINAL SPIROCHETES ASSOCIATED WITH ASYMPTOMATIC COVID INFECTION

ABSTRACT

Purpose/Background: Intestinal spirochetosis has been described as a rare source of colitis caused by the organism Brachyspira pilosicoli. It is more commonly associated with an immunocompromised host, such as those with HIV or post transplant. Spirochetosis can also afflict the immunocompetent host. Hypothesis/Aim: We describe in this case report the diagnosis of intestinal spirochetosis via colonoscopy in an immunocompetent host. They presented with abdominal pain and diarrhea and tested positive for COVID-19. Methods/Interventions: A 60- year old man with history of unprotected intercourse with men but a negative infectious workup for HIV, HSV, gonorrhea and chlamydia presented after multiple weeks of abdominal pain and diarrhea. He reported no recent travels and had a negative colonoscopy 9 years prior. 6 weeks prior to his appointment in the colorectal office, he was in the ER with a CT scan demonstrating diffuse colitis and pulmonary changes consistent with COVID. He tested positive for the virus, despite a lack of symptoms. He followed up in the clinic with ongoing symptoms. An infections workup for GI pathogens, including ova and parasites, C diff, was negative. A colonoscopy was ordered. Results/Outcome(s) The colonoscopy did not reveal any evidence of colitis. Random biopsies of the entirety of the colon were taken. The pathology revealed spirochetes in the mucosa. He was treated with metronidazole with complete resolution of his symptoms. Limitations: This is limited by a single reported instance of a relatively rare entity and in this particular instance associated with COVID infection. Conclusions/Discussion: Intestinal spirochetosis represents an unusual cause of abdominal pain and diarrhea in humans. It has been more commonly associated with immunocompromised host or in certain regions of the world, such as the India and portions of Asia. This instance in an otherwise immunocompetent male with asymptomatic COVID infection represents a unique case. Its symptoms, diagnosis by colonoscopy, and cure with metronidazole reflect the traditional presentation, diagnostic modality and treatment pathway.