Published online Sep 29, 2022. doi: 10.5495/wjcid.v12.i2.69
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
Intestinal spirochetosis (IS) is caused by Brachyspira colonization of the gastr
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. Hem
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.