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Pneumatosis cystoides coli associated with intestinal spirochetosis

Published:October 31, 2022DOI:https://doi.org/10.1016/j.dld.2022.10.008
      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 1
      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).
      Fig 2
      Fig. 2Pathological examination revealed edematous and mild non-specific inflammatory cell infiltration; H&E, x10 (A). Diffuse fringe formation was apparent along the colonic surface epithelium, suggesting intestinal spirochetosis; H&E, x200 (B, arrows). Immunohistochemistry for Treponema pallidum (C). Following a 10-day therapy of metronidazole, PCC recovered almost entirely (D).
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      Reference

        • Miwa W
        • Hiratsuka T
        • Sato K
        • et al.
        Pneumatosis cystoides intestinalis accompanied by intestinal spirochetosis.
        Clin J Gastroenterol. 2020; 13: 545-551