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General practice and family medicine
Usefulness of newer testing modalities for the accurate diagnosis of culture-negative endocarditis
  1. Lauren N Hirth1,
  2. Alexis Holman2,
  3. Jake Levine2 and
  4. Kenneth Tobin3
  1. 1Medical School, University of Michigan Medical School, Ann Arbor, Michigan, USA
  2. 2Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
  3. 3Cardiovascular Disease, Internal Medicine, University of Michigan Michigan Medicine, Ann Arbor, Michigan, USA
  1. Correspondence to Lauren N Hirth; lnhirth{at}umich.edu

Abstract

A woman in her 80s with a history of congestive heart failure, atrial arrhythmia treated with atrioventricular nodal ablation and permanent pacemaker (PPM) placement, mitral valve disease status post-repair and colon cancer status post-treatment was admitted for further evaluation of severe dyspnea on exertion. Imaging revealed vegetation on both the prosthetic mitral valve and the PPM lead. Blood cultures were collected without growth, so a cell-free DNA Karius test was performed, which can detect over 1000 pathogens and has a sensitivity between 87% and 93%. Testing returned positive results for Streptococcus bovis subspecies pasteurianus. Given its association with colorectal cancer, abdominal imaging and an endoscopic biopsy were performed, showing recurrent colonic malignancy. The patient underwent a right colon resection prior to cardiac intervention. This report describes the clinical application of the novel cell-free DNA Karius test, which led to the diagnosis of recurrent colon cancer associated with S. pasteurianus endocarditis.

  • Valvar diseases
  • General practice / family medicine
  • Gastrointestinal Stromal Tumors
  • Infectious diseases

https://doi.org/10.1136/bcr-2024-260163

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms and critical revision for important intellectual content: LNH, AH, JL and KT. The following authors gave final approval of the manuscript: LNH, AH, JL and KT. KT is a senior author.

    • 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.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

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