An Uncommon Cause of Diarrhoea and the Importance of an Internist Approach

BACKGROUND: Human intestinal spirochetosis is a condition defined by the presence of spirochetes attached to the colonic epithelium. Brachyspira aalborgi and Brachyspira pilosicoli may cause the disease in humans. CASE REPORT: We describe the case of a 58-year-old patient who presented with epigastric abdominal pain and diarrhoea. He was thought to be having a myocardial infarction and underwent an angiogram with subsequent stenting of the circumflex coronary artery. However, the pain and diarrhoea were still present after the procedure and the patient now had sepsis. An exploratory laparotomy was inconclusive. The patient improved on intravenous antibiotics and was discharged, but returned to the emergency department 2 days later with the same complaints. He was then admitted to an internal medicine ward where the diagnosis of intestinal spirochetosis was made. The patient was started on metronidazol and completed a 10-day antibiotic course with full recovery of his symptoms. CONCLUSION: This case highlights the importance of an internist-based approach that could have prevented two invasive procedures and the accompanying risks. LEARNING POINTS: Uncommon causes of diarrhoea are a diagnostic challenge. Errors of clinical judgement can lead to invasive and potentially harmful procedures. An internist-based approach can prevent diagnostic mistakes and be in the patient’s best interests.