BMJ Case Reports 2013; doi:10.1136/bcr-2013-008709

Late Streptococcus bovis infection of total knee replacement complicated by infective endocarditis and associated with colonic ulcers

  1. Graham Watson Keys1
  1. 1Department of Trauma and Orthopaedic Surgery, Macclesfield District General Hospital, Macclesfield, UK
  2. 2University Hospitals of Morecambe Bay, Furness General Hopital, Barrow-In-Furness, UK
  1. Correspondence to Dr Mathias Thomas Nagy, dr.nagy{at}


Streptococcus bovis is rare cause of late infections after total knee replacement (TKR). This report presents a case of confirmed late septic arthritis following TKR caused by S bovis that was further complicated with infective endocarditis resulting in aortic valve insufficiency in an immunecompetent patient. As an association between S bovis and gastrointestinal malignancies is suggested, a workup for such malignancies was performed that revealed non-malignant ulcers in patient's ascending colon. The patient is currently recovering from his aortic valve replacement surgery and is scheduled to have annual colonoscopies. His knee joint has improved; however, he developed constant pain because of underlying chronic infection in the affected joint and has difficulties mobilising. Therefore, a revision TKR is considered but postponed until he fully recovers from his heart valve surgery.

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