Q: 54 year old male is admitted to ICU with chills, fever and new onset of murmur. Patient is diagnosed with 'Streptococcus Bovis' endocardititis after 4 bottles reported positive for blood culture and vegetation on mitral valve found on Echo. What should be your next concern?


Answer: Colon cancer

About 7 percent of all infective endocarditis occurs due to 'Streptococcus Bovis', which has high association with colon cancer as well as underling inflammatory bowed disease (IBD). 54 is somewhate late for diagnosis of IBD and should raise high suspicion of colon cancer. Another bacteria which is highly associated with colon cancer is Clostridium septicum. 


References: 

1.  Corredoira-Sánchez J, García-Garrote F, Rabuñal R, et al. Association between bacteremia due to Streptococcus gallolyticus subsp. gallolyticus (Streptococcus bovis I) and colorectal neoplasia: a case-control study. Clin Infect Dis 2012; 55:491.

2.  Boleij A, van Gelder MM, Swinkels DW, Tjalsma H. Clinical Importance of Streptococcus gallolyticus infection among colorectal cancer patients: systematic review and meta-analysis. Clin Infect Dis 2011; 53:870. 

3.  Moshkowitz M, Arber N, Wajsman R, et al. Streptococcus bovis endocarditis as a presenting manifestation of idiopathic ulcerative colitis.

4.  Postgrad Med J 1992; 68:930. Boleij A, Schaeps RM, Tjalsma H. Association between Streptococcus bovis and colon cancer. J Clin Microbiol 2009; 47:516.