P2081 - Who Did It? A Rare Case of Unintentional Weight Loss and Diarrhea In A Young Immunocompetent Patient

Navkiran Randhawa, DO¹, Kwabena O. Adu-Gyamfi, MD², Prabhat Kumar, MD³, Gautam Maddineni, MD⁴, Leonard Little, MD^5
1Medical College of Georgia at Augusta University, Augusta, GA; ²Medical College of Georgia, Augusta University, Augusta, GA; ³Cleveland Clinic Foundation, Cleveland, OH; ⁴Florida State University, Cape Coral, FL; ⁵Charlie Norwood VA Medical Center, Augusta, GA

Introduction: Intestinal spirochetosis (IS) is a rare infection seen in as little as 2.5% of western countries to up to 16% in developing countries. This involves the colonization of non-treponemal B. aalborgi or B. pilosicoli. into colonic mucosa and commonly is seen in immunocompromised patients. We present a case of an immunocompetent patient who presented with nausea, loose stools and unintentional weight loss of 20 pounds.

Case Description/Methods: A 37-year-old African American male with a past medical history of PTSD presented to the gastroenterology clinic for abdominal pain with associated nausea, loose stools and unintentional weight loss of 20 pounds over 5 months after attending a wedding 2 months prior. He reported liquid stools that occur three to seven times a day without hematochezia or melena. He denied any family history of GI cancers. An HIV test was negative. A CT scan of the abdomen revealed mild nonspecific diffuse wall thickening and enhancement of multiple loops of mildly distended small and large bowel. The patient underwent a routine EGD, which revealed diffuse mucosal erythema with biopsies revealing helicobacter pylori. Duodenal biopsies revealed moderate chronic active duodenitis with diffuse villous atrophy. A colonoscopy revealed one polyp and otherwise was normal. Cecal polyp and random colon biopsies revealed intestinal spiroctetosis involving the background colonic mucosa. The patient was then treated with medications for H. pylori, which includes the treatment of symptomatic intestinal spirochetosis, metronidazole.

Discussion: IS is commonly transmitted through a fecal-oral route and are commonly seen in developed countries and immunocompromised patients. While most patients are asymptomatic, IS should be a differential in patients presenting with abdominal discomfort, weight loss and diarrhea as highlighted in this case report.


Disclosures:


Navkiran Randhawa, DO¹, Kwabena O. Adu-Gyamfi, MD², Prabhat Kumar, MD³, Gautam Maddineni, MD⁴, Leonard Little, MD⁵. P2081 - Who Did It? A Rare Case of Unintentional Weight Loss and Diarrhea In A Young Immunocompetent Patient, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.