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This report summarises a case history in which a 75-year-old man was admitted with bacterial meningitis caused by Streptococcus bovis. A subsequent abdominal investigation in the light of the known association between invasive S bovis infection and colonic cancer confirmed the suspicion of a cancer located to the rectum. The patient died from Clostridium difficile enterocolitis with sepsis and multi-organ failure. This is a highly relevant and interesting case presentation, which besides providing a learning point that patients with S bovis infection should undergo investigation for abdominal cancer, describes a 'best practice' pattern in which clinicians followed up on a known association between a rare clinical presentation and underlying disease.