Mahati Paravathaneni, MD1, Shengnan Zheng, MD1, Vihitha Thota, MD1, Chen Song, MD1, Daniel Sung, MD2; 1Mercy Catholic Medical Center, Darby, PA; 2Mercy Philadelphia Hospital, Darby, PA
Introduction: Infective Endocarditis (IE) is a rare condition affecting 12.7 cases per hundred thousand person-year in the United States. Although IE by Streptococcus Bovis and its association with GI malignancy (20-80%) had been well-established, association with other rarer forms of Streptococcus species is less recognized. Here, we discuss an unusual case of Streptococcus Sanguis (SS) endocarditis associated with mucinous colon adenocarcinoma.
Methods: A 62-year-old female with a past medical history of hypertension, systolic heart failure (EF 45-50%), and prosthetic mitral valve presented with hypotension, lethargy, and blood in the stool. Labs showed hemoglobin (5.7g/dL), and positive heme-occult. She was admitted for symptomatic anemia due to gastrointestinal (GI) bleed and received blood transfusions with significant clinical improvement. GI specialist performed upper endoscopy and colonoscopy, which showed erosive gastritis/duodenitis and a 6cm fungating tumor in splenic fracture, causing ulcerated narrowing. Pathologic studies diagnosed mucinous colon adenocarcinoma with AJCC pathologic stage pT3N1a. The patient underwent right hemicolectomy with anastomosis without any major complications. However, she remained sinus-tachycardia post-surgery, with episodes of sustained supraventricular-tachycardia on telemetry monitoring, despite adequate supportive management. CT chest angiography ruled out pulmonary embolism, and the patient was started on digoxin. At this time, blood culture obtained returned positive for SS in all four specimens, and the patient was started on antibiotics. She had no fever, chills, and denied any recent dental procedure. Trans-esophageal echocardiogram showed vegetation attached to the prosthetic mitral valve (~1.3cm). The patient was transferred to a tertiary center for prosthetic valve surgery. Discussion: SS is an alpha-hemolytic gram-positive coccus, commonly seen as oral plaque biofilm flora, and occasionally seen in the GI tract. It is rarely identified as a cause of bacteremia/endocarditis in patients without documentation of poor dentition and recent dental procedures. In our patient, we suspect SS penetrated bloodstream from the ulcerating colonic malignancy, causing bacteremia, thus endocarditis with mitral valve vegetation. It is highly essential to keep a strong clinical suspicion of colonic malignancy when encountering endocarditis/bacteremia from rare Streptococcus species, as early detection and management can help prevent catastrophic outcomes.
Disclosures: Mahati Paravathaneni indicated no relevant financial relationships. Shengnan Zheng indicated no relevant financial relationships. Vihitha Thota indicated no relevant financial relationships. Chen Song indicated no relevant financial relationships. Daniel Sung indicated no relevant financial relationships.