CASE REPORT

42-year-old male patient who came to the hospital for diarrhea with 5-6 bowel movements a day. The patient associates the onset of clinical eating a hamburger. The clinic gets worse with new intakes, and it did not improve with dietary measures. As usual treatment, the patient was intake Tenofovir (1-0-0) for 3 years in pre-exposure therapy due to contact with his HIV partner. Endoscopy was performed with ulcers and parasites (figure 1) and multiple biopsies were performed (figure 2).

Figure 2. Histological examination HE 400X (a), PAS 400X (b) Silver 400x (c) and PAS 200x (d). 

The patient underwent endoscopy with poor preparation of the colon due to the presence of dense intraluminal fecal remains adhering to the wall, which were partially mobilized with the washes but which prevent large areas from being seen (Boston 1 + 2 + 1). He advanced until the cecal pole was intubated, observing a normal valve. Multiple stellates and serpiginous ulcers with a yellowish background and edema at the edges are observed throughout the colon and rectum. All of them presented innumerable millimeter and filiform parasites lodged in the beds of the ulcers. The affectation is more marked in the appendicular area, intensely congestive, with mucosal edema and extrusion of the tissue, producing a false appearance of friable neoformation when rubbing. A sample was taken for microbiology and pathological anatomy.

In the microbiological study, no growth was observed in the cultures, with frequent Endolimax Nana cysts being observed.

Histological examination revealed oval structures with an external cuticle compatible with enterobius and the presence of an apical fringe in the intestinal glands showing PAS and Silver staining. These findings are consistent with the spirochetes. Diagnosis: Roundworms compatible with enterobius vermicularis and human intestinal spirochetosis.

DISCUSSION

Spirochetosis infection was described by Harland and Lee¹ in 1971 in patients without an obvious associated clinical outcome. The infection is more prevalent in men, being more frequent if there are homosexual relationships. The prevalence varies from 2 to 9% in Europe², although it has increased year after year in Asian studies³. Associated symptoms are usually rare. The clinical presentation can vary from the absence of symptoms to the presence of abdominal pain (46%), diarrhea (51%), alternating diarrhea/constipation (13%) and rectal bleeding⁴. In our case, the relationship with helminths is more likely.

The interest of the case lies in the confusion due to cross-reactions with T. pallidum and the difficulty of diagnosis by culture and that it must be included in the differential diagnosis of a patient who presents risky contacts with an HIV partner.

The route of transmission is not clear, but there is a difference in the incidence of eating habits, sexual and hygienic-sanitary habits of the populations studied⁵.