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Journal of Pediatric Gastroenterology & Nutrition:
doi: 10.1097/MPG.0b013e31821646ca
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A 14-Year-Old With Rectal Bleeding and Abdominal Pain

Gupta, Rohit*; Wellman, Greg; Hussain, Sunny Z.

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*Department of Pediatrics, LSU Health Sciences Center

Delta Pathology

WK Pediatric Gastroenterology & Research, Shreveport, LA.

Address correspondence and reprint requests to Sunny Z. Hussain, MD, WK Pediatric Gastroenterology & Research, 2508 Bert Kouns, Shreveport, LA 71118 (e-mail: shussain@wkhs.com).

The authors report no conflicts of interest.

Submissions for the Image of the Month should include high-quality TIF endoscopic images of unusual or informative findings. In addition, 1 or 2 other associated photographs, such as radiological or pathological images, can be submitted. A brief description of no more than 200 words should accompany the images. Submissions are to be made online at http://www.jpgn.org, and will undergo peer review by members of the NASPGHAN Endoscopy and Procedures Committee, as well as by the www.jpgn.org.

A 14-year-old girl presented with a 6-week history of intermittent rectal bleeding and occasional nonspecific abdominal pain. A review of systems, physical examination, and laboratory workup did not elicit a cause for her symptoms (Fig. 1–3). She underwent colonoscopy, which was grossly normal, but histopathology of biopsy specimens showed heavily colonized transverse and descending colon with spirochetes. Spirochete specific staining using silver impregnation (Steiner stain) was used to confirm spirochetosis. Intestinal spirochetosis (IS), although a veterinary problem, is gaining recognition as a human quandary (1,2). The most common organisms involved are Brachyspira aalborgi and Brachyspira pilosicoli, the general source is infected swine and poultry populations, and the usual mode of transmission is fecal–oral. Absence of a clear clinicopathological correlation and divergent approaches in managing patients have generated a debate regarding the clinical significance and management of IS. Some consider IS as a self-limiting infection that, when treated, does not always lead to eradication of spirochetes or elimination of symptoms (3). Immunocompromised, HIV-infected, and homosexual males have a higher rate of infection (4). Patients with severe symptoms and those who are immunocompromised should receive treatment. Polymerase chain reaction assays or other more specific diagnostic modalities can be used for diagnosis before endoscopy. Our patient received treatment with 2 weeks of metronidazole and erythromycin, which is the recommended regimen for pediatric patients (5). Upon conclusion of antibiotics, she had resolution of her abdominal pain and rectal bleeding.

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REFERENCES

1. Harland WA, Lee FD. Intestinal spirochaetosis. Br Med J 1967; 3:718–719.

2. Carpentieri DF, Souza-Morones S, Gardetto JS, et al. Intestinal spirochaetosis in children: five new cases and a twenty-year review of literature. Pediatr Dev Pathol 2010;3:471–5.

3. O’Donnell S, Swan N, Crotty P, et al. Assessment of the clinical significance of intestinal spirochaetosis. J Clin Pathol 2008; 61:1029–1033.

4. Higashiyama M, Ogata S, Adachi Y, et al. Human intestinal spirochetosis accompanied by human immunodeficiency virus infection: a case report. Acta Med Okayama 2009; 63:217–221.

5. Brooke CJ, Hampson DJ, Riley TV. In vitro antimicrobial susceptibility of Brachyspira pilosicoli isolates from humans. Antimicrob Agents Chemother 2003; 47:2354–2357.

Copyright 2011 by ESPGHAN and NASPGHAN

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