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Human intestinal spirochetosis mimicking ulcerative colitis

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Abstract

Human intestinal spirochetosis (HIS) is a colorectal infection caused by the Brachyspira species of intestinal spirochetes, whose pathogenicity in humans remains unclear owing to the lack of or mild symptoms. We monitored the 5-year clinical course of a woman diagnosed with HIS in whom ulcerative colitis (UC) had been suspected. Following a positive fecal occult blood test, she underwent a colonoscopic examination at a local clinic where she was diagnosed with “right-sided” UC concomitant with incidentally detected HIS, and was referred to our hospital. Colonoscopic, histopathological, and cytological examination revealed localized erosive colitis in the ascending and the right transverse colon concomitant with HIS resembling skip lesions of UC. Initially, we chose the wait-and-watch approach; however, she gradually developed bloody diarrhea. Metronidazole improved her abdominal symptoms, as well as her colonoscopic and histopathological findings, suggesting that HIS was responsible for her colorectal inflammation. This case reveals (1) a possible pro-inflammatory role of HIS, (2) difficulties in diagnosing HIS in chronic proctocolitis, and (3) a possible inclusion of some HIS cases in “UC”. HIS could mimic UC and might be included in differential diagnoses for UC. Antibiotic administration is necessary following the detection of HIS, particularly in patients demonstrating an atypical presentation of UC.

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Authors and Affiliations

  1. Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan

    Shin Nishii, Masaaki Higashiyama, Shunsuke Komoto, Suguru Ito, Akinori Mizoguchi, Hisato Terada, Hirotaka Furuhashi, Takeshi Takajo, Kazuhiko Shirakabe, Chikako Watanabe, Kengo Tomita, Shigeaki Nagao, Soichiro Miura & Ryota Hokari

  2. Department of Laboratory Medicine, National Defense Medical College Hospital, Tokorozawa, Japan

    Sho Ogata

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  1. Shin Nishii
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  2. Masaaki Higashiyama
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  3. Sho Ogata
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  4. Shunsuke Komoto
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  5. Suguru Ito
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  6. Akinori Mizoguchi
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  13. Shigeaki Nagao
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  14. Soichiro Miura
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  15. Ryota Hokari
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Corresponding author

Correspondence to Masaaki Higashiyama.

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All authors declare that they have no competing interests.

Human/animal rights

All procedures followed in this study were in accordance with the ethical standards recommended by the Response Committee on Human Experimentation (Institutional and National) and with the Helsinki Declaration of 1975, as revised in 2008(5).

Informed consent

Informed consent was obtained from the patient whose case we present in this study.

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Nishii, S., Higashiyama, M., Ogata, S. et al. Human intestinal spirochetosis mimicking ulcerative colitis. Clin J Gastroenterol 11, 145–149 (2018). https://doi.org/10.1007/s12328-017-0807-3

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  • DOI: https://doi.org/10.1007/s12328-017-0807-3

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