Infective Endocarditis After Endoscopic Stricture Dilation in Crohn's Disease

Area of Science:

• Gastroenterology
• Infectious Diseases
• Cardiology

Background:

• Crohn's disease frequently causes intestinal strictures, often managed with endoscopic balloon dilation.
• Managing Crohn's disease involves immunosuppressive therapies like azathioprine and infliximab.
• Patients with prosthetic heart valves are at increased risk for infective endocarditis.

Observation:

• A 61-year-old male with a history of Crohn's disease and a biological aortic prosthesis underwent endoscopic balloon dilation for a colonic stricture.
• Prophylactic antibiotics were not administered during the procedure.
• The patient subsequently developed Streptococcus gallolyticus endocarditis.

Findings:

• A case of late-onset Streptococcus gallolyticus endocarditis was identified.
• The endocarditis was temporally associated with endoscopic balloon dilation of a Crohn's-related colonic stricture.
• The patient required aortic valve replacement due to the endocarditis.

Implications:

• Endoscopic procedures, including balloon dilation for Crohn's strictures, may pose an infection risk, particularly for patients with prosthetic valves.
• The association suggests a potential link between gastrointestinal manipulation and Streptococcus gallolyticus bacteremia/endocarditis.
• Further investigation into prophylactic antibiotic strategies for high-risk patients undergoing endoscopic gastrointestinal interventions is warranted.