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We present a case (57-year-old man) of infective endocarditis caused by Streptococcus gallolyticus in a patient with incident early-stage colon cancer. Benzylpenicillin treatment was immediately initiated to control bacteremia, and curative cancer resection was conducted 1 week later. The patient was discharged and placed on a 6-week outpatient parenteral anti-biotic therapy program for infective endocarditis but was rehospitalized 2 months later for heart failure. Transesophageal echocardiography revealed multiple large vegetations and perforation of the aortic valve. Valve replacement was conducted successfully, and heart failure was alleviated. This case highlights the dilemma of prioritizing the management of two competing interests, one for heart failure caused by valve regurgitation and the other for early-stage colon cancer with a curative intent. In this case, curative resection of the colon cancer was conducted after reasonable control of the endocarditis. Perforation of the aortic valve and heart failure could have been avoided if valve replacement was conducted first, but at the risk of cancer progression.

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