Streptococcus Bovis Endocarditis Post Colonic Polypectomy

Abstract

We describe a case of Streptococcus lutetiensis infective endocarditis occurring in a patient following colonic polypectomy. The patient had multiple risk factors for infective endocarditis including pre-existing mitral valve prolapse and regurgitation. Transoesophageal echocardiography revealed a friable mass on the posterior mitral valve leaflet, confirming the diagnosis. The patient was treated with intravenous antibiotics, successfully underwent mitral valve surgery and was discharged home for outpatient follow-up. This report details an uncommon case presentation, highlights areas for improvement in clinical practice, and summarises the current knowledge available in the literature regarding Streptococcus bovis infective endocarditis. LEARNING POINTS Infective endocarditis occurring in association with gastrointestinal endoscopy is rare. Clinical suspicion of infective endocarditis after colonic polypectomy or biopsy should be maintained, especially in those with risk factors for infective endocarditis. Antibiotic prophylaxis against infective endocarditis is not recommended for routine gastrointestinal endoscopic procedures.

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“…Diagnostic gastroscopy, colonoscopy and flexible rectosigmoidoscopy are considered low risk for infection and bacteremia [4,17]. Although a recent case of Streptococcus Bovis endocarditis has been reported after colonoscopic polypectomy, authors concluded that performing biopsy and polypectomy during the procedure is considered low-risk for infection and bacteremia [18].…”

Characterization of Streptococcus lutetiensis isolated from clinical mastitis of dairy cows

“…In humans, Strep. lutetiensis was (1) detected in a patient with endocarditis (Chongprasertpon et al, 2019); (2) isolated from a child with diarrhea (Jin et al, 2013); and (3) present in blood samples from a patient with cholangitis (Almuzara et al, 2013). In animals, Piva et al (2019)…”