BMJ Case Reports 2011; doi:10.1136/bcr.09.2011.4814
  • Reminder of important clinical lesson

Getting to the heart of rectal bleeding: subacute bacterial endocarditis presenting as anaemia and a GI bleed

  1. Mukta Panda3
  1. 1Department of Medicine, University of Tennessee, Memphis, Chattanooga, Tennessee, United States
  2. 2Department of Medicine, University of Tennessee, Chattannoga, Hixson, Tennessee, United States
  3. 3Department of Medicine, University of Tennessee, Chattanooga, Chattanooga, Tennessee, United States
  1. Correspondence to Dr Christy Stewart, christy.stewart{at}


In this case report, the authors demonstrate a case of subacute bacterial endocarditis presenting with anaemia. It is the first of its kind to describe a delay in diagnosis due to an initial patient investigation for a bleed rather than a cardiac evaluation. Astute clinicians need to be aware of the causes of anaemia in patients with endocarditis and consider that in Streptococcus bovis (S bovis) infection can be related to gastrointestinal polyps or malignancy resulting in bleeding. Although patients with S bovis endocarditis should undergo full gastrointestinal investigation after endocarditis is diagnosed, it should not delay medical treatment. In this article, the authors discuss the consequences of failing to achieve timely recognition of endocarditis along with common systemic complications. The authors also outline current recommendations for surgical intervention as heart valve replacement surgery was warranted in the patient to prevent fatal outcome.


  • Competing interests None.

  • Patient consent Obtained.

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