Intestinal spirochetosis as a cause of chronic diarrhoea in patients with HIV infection: case report and review of the literature.

We describe a 77-year-old patient with HIV infection suffering from chronic diarrhoea whose colonoscopy findings showed normal appearance mucosa and tissue samples revealed the presence of a dense layer of spirochetes attached to the apical cell membrane. A literature search from 1996 to April 2009 identified 19 additional cases of intestinal spirochetosis in patients with HIV infection. Analysis of cases showed that intestinal spirochetosis causes chronic diarrhoea in men who have sex with men (92% of patients with reported HIV infection risk factors) who are not severely immunosuppressed (70% with CD4 lymphocyte cells >200/microL). Colonoscopy examination often revealed normal appearance mucosa. Haematoxylin and eosin stain of biopsy samples showed the presence of spirochetes, but Warthin-Starry silver staining makes organisms easier to detect. Patients promptly responded to metronidazole or penicillin therapy. In summary, invasive intestinal spirochetosis should be considered in the differential diagnosis of patients with HIV infection and chronic diarrhoea.

[Necrotizing sarcoid granulomatosis: a case report and review of the literature]. / Granulomatosis necrotizante sarcoidea: presentación de un caso y revisión de la literatura.

A patient with asymptomatic necrotizing sarcoid granulomatosis is reported. There were bilateral nodules in the chest radiograph but no mediastinal adenopathies were seen on a computed tomography scan. The transbronchial biopsy specimens under fluoroscopy guidance achieved the diagnosis. Steroid treatment was started. The nodules disappeared in three months and reappeared two months later when the patient decided to stop treatment. After two years of follow up the nodules disappeared spontaneously. This is a rare and seldom reported entity, considered by some authors as being and atypical form of sarcoid.