Calcium polystyrene sulfonate-induced rectal ulcer causing E. coli native-valve infective endocarditis

Area of Science:

• Medicine
• Gastroenterology
• Infectious Diseases

Background:

• Native-valve infective endocarditis (NVE) is rare, particularly when associated with Escherichia coli.
• Elderly patients with comorbidities like diabetes mellitus, malignancy, and renal failure are at higher risk.
• Long-term use of calcium polystyrene sulfonate (CPS) is linked to gastrointestinal mucosal damage and colorectal ulcers.

Observation:

• A 66-year-old Japanese man with diabetes and renal failure, on CPS for 11 years, presented with altered consciousness.
• He was diagnosed with E. coli bacteremia, multiple cerebral infarctions, and an acute hemorrhagic rectal ulcer.
• Transesophageal echocardiography revealed a mitral valve vegetation, confirming E. coli NVE.

Findings:

• The patient underwent rectal resection and mitral valve replacement but died post-surgery.
• Pathological examination of the rectum showed CPS deposition, confirming a CPS-induced ulcer.
• This ulcer likely served as the source of bacterial translocation leading to E. coli bacteremia and endocarditis.

Implications:

• Long-term CPS use poses a significant risk for developing colorectal ulcers.
• These ulcers can act as a portal for bacterial translocation, potentially causing severe systemic infections like infective endocarditis.
• Clinicians should consider this risk in patients on long-term CPS therapy, especially those with risk factors.