Possible misdiagnosis

I know this type of post can come off as wishful thinking but I just wanted to throw around some ideas that I've had in my head recently.

I'm a 31 year old male. I've always been really healthy: eat lots of fruits and vegetables, don't smoke, don't drink, run about 4 times a week. Last year I was sexually infected with Giardia through a partner I didn't realize was not being faithful at the time. I knew the morning after that something wasn't right and I just felt very ill. My stools were immediately bloody and contained a lot of mucous and I had severe cramping and bloating. The pain was deep and dull and I quickly realized that something was wrong. There were many nights where I would have a fever and sweat through my clothes even though the A/C was set around 67 degrees. Things escalated quickly to the typical symptoms of UC, multiple bm, frequent accidents, urgency, etc etc. It wasn't until about 3 months later that I was able to get in to see someone because I'm a medical student and there's no way to get into a GI doc outside the hours of 8-5. She had me submit blood work and stool samples. My bloodwork came back first and showed markers of inflammation (high monocyte diff, high esr, high c-reactive protein). Basically the results weren't enough to differentiate from a chronic inflammatory disease (like UC) or some other infection. Then my stool sample came back and was positive for Giardia. They put me on a 7 day metronidazole regimen that seemed to help for a few weeks. Since my school year was almost done and I was about to head back home for summer, I had already scheduled a colonoscopy with my GI doctor back home (school in ohio, home in denver). He found mod-severe inflammation in the transverse and descending colon and diagnosed me with ulcerative colitis.

Fast forward to today. I've had my ups and downs but I've been fairly successful at controlling things with simple diet and Lialda. It's been a year now since they detected giardia and all of my subsequent stool samples have come back negative for giardia (or anything else). I'm still not too well controlled: I wake up twice in the night to use the restroom and probably go throughout the day about 3-4 times. My stools are never formed and probably bloody about every other time. My doctor (in Ohio) wants me to move forward with prednisone and then follow-up with either entyvio or humira. I'm tired of dealing with this so I'm getting ready to move forward but I was thinking maybe I should rule everything out one last time before I head down the path of immunosuppression.

My research has led me to realize that Giardia doesn't always go away with the first round of antibiotic treatment. Also, giardia can be difficult to detect and stool sample results aren't always accurate, so that could possibly explain the negative results subsequent to therapy. Do you think it would be worth it for me to try one more heavy round of antibiotics before I go through with these infusions? I can't reconcile the weird coincidence that I've never had GI issues in my life and then all of the sudden when I get giardia suddenly I have UC. Isn't there a possibility there was residual infection when I had my colonoscopy? Some of my symptoms (nights sweats, fever) seem much more indicative of an infection. It just seems like deciding to go through with UC therapy is a decision that you don't really turn back from. I know that antibiotics are a real danger, especially for someone with UC, but what's worse: going through immunosuppressive therapy when you really have an infection or possibly aggravating UC with antibiotics when you already have UC? Seems like the worst thing more antibiotics can do is make me deal with something I've already been dealing with, but the potential for improvement is too big to ignore.

Anyway, sorry this is a lot to post. You guys are super helpful and I'm just trying to get some of your thoughts on this issue.

I guess the reason I'm suspecting it is because I've had symptoms that seem more related to infection (fever, night sweats, chills, muscle aches). Giardia has two stages (cyst and trophozoite). The cyst only has about a 2 week period where it can be detected in the feces and the trophozoite has to be observed within 15 min of excretion to be detected in the feces. Seems like that would rarely be the case since it takes me a while to get it to the hospital. But they didn't do any biopsies with my colonoscopy unfortunately.

You will need biopsies to be sure. I think it is a long shot.
Giardia is an intestinal parasite that might be fought off by healthy gut microbe ecology. IT is very likely the infection bloomed because UC had thrown you gut ecology into dysbiosis. There is some question of cause and effect here.

It is possible, that a round of antibiotics, followed by large round of pro-biotics, could have little lasting impact on your UC. Of course there is some risk.

good luck

starvedstudent said...
I guess the reason I'm suspecting it is because I've had symptoms that seem more related to infection (fever, night sweats, chills, muscle aches). Giardia has two stages (cyst and trophozoite). The cyst only has about a 2 week period where it can be detected in the feces and the trophozoite has to be observed within 15 min of excretion to be detected in the feces. Seems like that would rarely be the case since it takes me a while to get it to the hospital. But they didn't do any biopsies with my colonoscopy unfortunately.

Fever, night sweats, chills, muscle aches, etc, all can occur with 'autoimmune' diseases like UC just as much as they occur with infectious diseases.

What's more, giardia isn't really known for causing bloody diarrhea as far as I know. Voluminous watery diarrhea is its hallmark.

I'd be shocked if they didn't do any biopsies. It's standard procedure to do so any time they see something unusual, ie, they only *don't* do biopsies if your colon looks pristine during a routine colonoscopy. For somebody with symptoms of a disease and with visible inflammation in the colon, biopsies are a must.