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Bacteroides fragilis endocarditis in a patient with Crohn's disease

Shailendra Singh1, Vishal Goyal, Parikshit Padhi

  • 1Division of Internal Medicine, West Penn Allegheny Health System, Pittsburgh, Pennsylvania, USA. ssingh1@wpahs.org

BMJ Case Reports
|April 23, 2013
PubMed

Insights

Bacteroides fragilis endocarditis is rare, especially in Crohn's disease patients. This case highlights the need to consider anaerobic bacteria in diagnosing endocarditis and identifying its source.

Area of Science:

  • Infectious Diseases
  • Cardiology
  • Gastroenterology

Background:

  • Bacteroides fragilis is an uncommon pathogen in infective endocarditis.
  • The association between Bacteroides fragilis and Crohn's disease in endocarditis has not been previously reported.
  • Severe left ventricular dysfunction can lead to thrombus formation, serving as a potential site for bacterial seeding.

Observation:

  • A 44-year-old male with a history of Crohn's disease presented with symptoms of generalized weakness, fever, and cyanotic foot discoloration.
  • Echocardiography revealed intraventricular echo densities suggestive of vegetations.
  • Blood cultures identified Bacteroides fragilis, and colonoscopy showed multiple fistulous openings consistent with Crohn's disease.

Findings:

  • The patient was diagnosed with Bacteroides fragilis bacteremia and endocarditis.
  • The endocarditis was attributed to the seeding of a left ventricular thrombus.
  • Crohn's disease was confirmed via biopsy following proctocolectomy.

Implications:

  • This case underscores the importance of considering anaerobic bacteria, such as Bacteroides fragilis, as potential causes of endocarditis.
  • Early identification and source recognition are crucial for effective management of such rare infections.
  • The interplay between inflammatory bowel disease and infective endocarditis warrants further investigation.

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