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Enterococcus faecalis infective endocarditis arising from chronic rectal prolapse in the setting of spinal cord injury
  1. Harendra Maneesha De Silva1,
  2. Saliya Hewagama2 and
  3. Neil Strugnell1
  1. 1Department of General Surgery, The Northern Hospital, Epping, Victoria, Australia
  2. 2Department of General Medicine, The Northern Hospital, Epping, Victoria, Australia
  1. Correspondence to Dr Harendra Maneesha De Silva; harendramaneesha.desilva{at}nh.org.au

Abstract

A 45-year-old man had recurrent presentations with pleuritic chest pain and shortness of breath. Four months prior, he had developed cauda equina syndrome from a spinal epidural abscess in the setting of intravenous drug use, complicated by lasting neurological deficits and a rectal prolapse. On his final presentation, blood cultures taken in the absence of antibiotics grew Enterococcus faecalis from multiple sets. A transoesophageal echocardiogram confirmed tricuspid valve endocarditis. He recovered well post-targeted long-term antibiotics. Endoscopy confirmed a chronic rectal prolapse with multiple ulcers and was hypothesised as the source of bacteraemia. He subsequently underwent perineal rectosigmoidectomy. This uncommon sequela of rectal prolapse highlights several issues, including the management of neurogenic bowel dysfunction following spinal cord injury and the importance of early prolapse recognition and management. Finally, appropriate collection of blood cultures and correct use of echocardiography are critical steps in investigating infective endocarditis.

  • general surgery
  • valvar diseases

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Footnotes

  • Contributors HMDS: gathered data and prepared the manuscript. SH and NS: made critical revisions to the manuscript and were responsible for overall supervision of the project.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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