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Colon Cancer with Streptococcus gallolyticus Aortic Valve Endocarditis: A Missing Link?
Chukwunonso Chime1, Harish Patel1, Kishore Kumar1
1BronxCare Health System, A Clinical Affiliate of Mt Sinai Health Systems and an Academic Affiliate of Icahn School of Medicine, USA.
Case Reports in Gastrointestinal Medicine
|July 30, 2019
Summary
Streptococcus gallolyticus endocarditis is linked to colon cancer, particularly in immunocompromised patients. This case highlights altered immunity as a key factor and the rare co-occurrence of two Streptococcus species in cancer patients.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Oncology
Background:
- Bacterial endocarditis is a significant clinical concern, with Streptococcus gallolyticus (formerly S. bovis) notably associated with colorectal cancer.
- Current guidelines recommend colonoscopy for patients with S. gallolyticus endocarditis or bacteremia to screen for colorectal neoplasia.
- Prophylactic antibiotic use for endoscopic procedures remains unestablished, and post-colonoscopy bacteremia in patients with S. gallolyticus bacteremia has not been previously reported.
Observation:
- A 72-year-old male with newly diagnosed multiple myeloma presented with aortic valve endocarditis and S. gallolyticus bacteremia.
- Subsequent colonoscopy revealed colon cancer and high-grade adenoma.
- Hours after the procedure, the patient developed bacteremia with a different Streptococcus species, Streptococcus mitis.
Findings:
- This case reinforces the association between S. gallolyticus and colon cancer, especially in individuals with compromised immune systems.
- The case is unique in demonstrating the rare co-infection of two distinct Streptococcus species in a patient with underlying cancer.
- Altered immunity is proposed as a critical factor facilitating bacteremia in patients with S. gallolyticus-associated colon cancer.
Implications:
- The findings suggest that pre-endoscopic antibiotic prophylaxis might be considered for high-risk individuals, despite not being standard care.
- Altered immune status may represent a crucial link in the pathogenesis of bacteremia in the context of S. gallolyticus and colon cancer.
- Further research into the interplay between immunity, gut microbiota, and bacterial endocarditis in cancer patients is warranted.
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