VA Caribbean Healthcare System San Juan, PR, United States
Zeyn Mirza, MD, Diego Roman-Colon, MD, Jaime Martinez-Souss, MD, FACG VA Caribbean Healthcare System, San Juan, Puerto Rico
Introduction: General malaise, gait disturbances poor oral intake and anemia in an aging patient are symptoms that require a high rate of clinical suspicion to arrive at the correct diagnosis. This is further complicated in patients with history of recent endoscopic intervention when an accurate history is not taken. Millions of colonoscopies are done yearly with transient, self-limiting bacteremia affecting 4.4% of procedures reason why current guidelines do not recommend antibiotic prophylaxis. This is the case of a patient who developed Veillonella parvula bacteremia after a colonoscopy. To our knowledge there is only one reported case of said bacteremia after endoscopy and colonoscopy in the literature.
Case Description/Methods: An 88-year-old man with history of hypertension, diabetes mellitus type 2 that came to ER due to two-week onset of generalized weakness, anorexia and gait imbalance. Review of systems was otherwise negative and he was oriented in all spheres. Labs showed microcytic anemia, thrombocytopenia and acute kidney injury. During hospitalization his mental status rapidly deteriorated and workup including brain imaging, toxicology, heavy metal poisoning, TSH, syphilis were negative. A bone marrow biopsy revealed a hypocellular bone marrow. Patient developed worsening leukocytosis, severe metabolic acidosis, acute liver failure and hypotension requiring ICU care, broad-spectrum antibiotics, vasopressors and renal replacement therapy. Blood cultures later were positive for Veillonella parvula. Upon further questioning, patient had recent colonoscopy with multiple biopsies of two small tubular adenomas and a 1 cm serrated adenoma which was likely portal of entry. Multi organ failure ensued and the patient passed away.
Discussion: Veillonella parvula is strictly anaerobic organism that forms part of the intestinal flora. Sparse reports exist of discitis, osteomyelitis and endocarditis. Risk factors for infection include periodontal disease, immunodeficiency and IV drug use. Our patient had none of the above risk factors. Given his recent colonoscopy with biopsy and subsequent symptomatology, biopsy could be considered as the portal of entry. Identification of this organism is problematic as it is a strict anaerobe and susceptibility testing was not available to tailor treatment. This case highlights the importance of being aware of rare complications of colonoscopies and obtaining a complete history of recent interventions to ascertain possible etiologies of a patient’s current symptoms.
Zeyn Mirza indicated no relevant financial relationships.
Diego Roman-Colon indicated no relevant financial relationships.
Jaime Martinez-Souss indicated no relevant financial relationships.
Zeyn Mirza, MD, Diego Roman-Colon, MD, Jaime Martinez-Souss, MD, FACG. P2320 - The Veil of Ignorance: A Rare Complication of Colonoscopy, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.