Colonic spirochetosis associated with dermatomyositis.

A 37−year−old man presented with severe myalgia associated with abdominal pain and offensive−smelling diarrhea. He had an erythematous rash on his face, torso, and arms. His creatine kinase was raised at 30 145 IU/l (normal range 33 ± 199 IU/ l). Electromyography suggested myositis and a muscle biopsy confirmed a diagno− sis of dermatomyositis. On abdominal computed tomography he was found to have an edematous large bowel, with an appearance suggestive of inflammatory bowel disease. Fecal microscopy and stool cultures were unrevealing. Flexible sig− moidoscopy showed multiple, punctate hemorrhagic lesions (Figure 1). Biopsies showed a blue fringe along the surface of the colonic epithelium that was sugges− tive of spirochetosis (with no evidence of cytomegalovirus infection). The patient denied having any occupational contact with animals and he had not been abroad for several years. HIV serology was nega− tive; Borrelia burgdorferi IgG/IgM antibo− dies and parvovirus B19 IgM antibodies were undetectable.