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A 61-year-old asymptomatic man underwent colonoscopy during a medical check-up, which
revealed multiple translucent submucosal tumor-like lesions along the ascending and
transverse colon along with erythematous areas (Fig. 1A). Computed tomography (CT) colonography revealed multiple air-containing cysts within
the walls of the colon (Fig. 1B, C). Clostridioides difficile toxin was not detected in stools. We performed biopsies
of the cystic lesions. Histopathological examination revealed edematous and mild non-specific
inflammatory cell infiltration (Fig. 2A). Of note, diffuse fringe formation was also apparent along the colonic surface
epithelium in biopsy specimens, thus suggesting intestinal spirochetosis (IS) (Fig. 2B, arrows). Subsequent immunohistochemistry for Treponema pallidum further confirmed
the diagnosis of IS (Fig. 2C). Consequently, a diagnosis of concomitant pneumatosis cystoides coli (PCC) and
IS was established. Following a 10-day therapy of metronidazole (1000 mg/day), almost
complete resolution of PCC was noted (Fig. 2D), and no IS was seen on histological examination four months later.
Fig. 1Colonoscopy revealed multiple translucent submucosal tumor (SMT)-like lesions ranging
in size from 5 mm to 2 cm, distributed along the ascending and transverse colon (A).
Computed tomography (CT) colonography revealed multiple air-containing cysts within
the walls of the ascending and transverse colon (B, C).
