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Streptococcus bovis prosthetic valve endocarditis associated with silent colonic carcinoma
  1. Fatehi E Elzein1,
  2. M Yasin Akhtar2,
  3. Hatim Khairallah2,
  4. Ali Albenmousa3
  1. 1 Department of Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
  2. 2 Department of Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
  3. 3 Department of Gastroenterology and Hepatology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
  1. Correspondence to Dr Fatehi E Elzein, fatehielzein{at}


A 75-year-old woman was admitted to our hospital with a 3-month history of fever. Of note, she had a bioprosthetic mitral valve replacement 1 year prior to admission. Streptococcus bovis was isolated from three sets of blood cultures. An echocardiogram showed a flickering mass attached to the bioprosthesis. Her blood culture became sterile by the fourth day of ceftriaxone therapy. In spite of the absence of gastrointestinal symptoms, screening colonoscopy revealed an invasive colonic adenocarcinoma. The association linking S. bovis endocarditis and colonic tumours is well recognised. However, despite early reports of this association by Klein et al in 1979, a large number of practising physicians remain unaware of this phenomenon. This lack of awareness results in lost opportunities for early diagnosis and, consequently, improved outcome in such patients. Our report emphasises this association in an area with a low incidence of S. bovis endocarditis.

  • cardiovascular medicine
  • valvar diseases
  • infections
  • colon cancer

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  • Contributors FEE contributed to the management of the patient and writing up of the case, reviewed the literature and coordinated the submission process. MYA is the Infectious Diseases Senior Registrar. He participated in the management of the patient, gathered the investigations,and reviewed the case report. HK is the cardiologist following the patient. Arranged and performed the echocardiogram and provided the image of the echo. He had reviewed and revised the case report. AA is the gastroenterologist who performed the endoscopy and provided the images of the CT scan and endoscopic findings. He had reviewed and contributed extensively to the editing of the report.

  • Competing interests None declared.

  • Patient consent Obtained.

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