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Enterococcus faecalis Endocarditis After Endoscopic Mucosal Resection of a Large Sessile Colonic Polyp
Antonios Wehbeh1, Myron C Gerson2, Douglas K Rex1
1Division of Gastroenterology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN.
ACG Case Reports Journal
|October 18, 2019
Summary
Endoscopic mucosal resection for colon adenoma can lead to enterococcus faecalis endocarditis in patients with heart conditions. This rare complication highlights the importance of monitoring patients post-procedure.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Cardiology
Background:
- Colonoscopy with endoscopic mucosal resection (EMR) is a common procedure for removing precancerous lesions.
- Patients with pre-existing cardiac conditions, such as mitral regurgitation and cardiomyopathy, may be at increased risk for certain complications.
Observation:
- A 71-year-old male with a history of mitral regurgitation and apical cardiomyopathy underwent EMR for a large transverse colon tubulovillous adenoma.
- Six weeks post-EMR, the patient developed symptoms of infective endocarditis, including fever and positive blood cultures for Enterococcus faecalis.
Findings:
- The patient presented with valvular vegetations, indicative of endocarditis.
- Enterococcus faecalis was identified as the causative agent, strongly suggesting a link to the recent gastrointestinal procedure.
Implications:
- This case represents the first documented instance of native valve endocarditis following EMR.
- It underscores the potential risk of bacteremia and subsequent endocarditis after EMR, particularly in immunocompromised or cardiac patients.
- Further research is warranted to elucidate the exact mechanism and to establish optimal prophylactic or monitoring strategies.
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