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A novel source of enterococcal endocarditis
1Department of Internal Medicine, St. Vincent Hospital, Indianapolis, Indiana 46260, USA.
Abstract:
An important element of the evaluation of patients with infective endocarditis is the determination of an infectious source. In approximately 20-45% of cases, no source is identified. Often the specific organism involved implicates the source, as is classically described by the association of S. bovis with colonic neoplasia. Other gut organisms have been reported to infect heart valves when colorectal pathology is present, but at far less frequency than S. bovis. This report deals with the case of a 75-year-old man with Enterococcus faecalis endocarditis of an unusual source--a cecal carcinoma that was causing intermittent appendiceal obstruction and infection. This case adds to previous case reports which suggest that the occurrence of enterococcal endocarditis in the absence of a classic infectious source should lead to a search for occult colorectal pathology.
Insights
Identifying the source of infective endocarditis is crucial. This case highlights Enterococcus faecalis endocarditis linked to an unusual source, a cecal carcinoma, suggesting a need to investigate colorectal pathology when the source is unclear.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Cardiology
Background:
- Determining the infectious source is vital in managing infective endocarditis.
- A significant percentage of infective endocarditis cases remain without an identified source.
- Specific microorganisms can suggest the origin of infection, such as Streptococcus bovis with colonic neoplasia.
Observation:
- This report details a case of a 75-year-old male with Enterococcus faecalis endocarditis.
- The endocarditis originated from an uncommon source: a cecal carcinoma.
- The carcinoma caused intermittent appendiceal obstruction and infection.
Findings:
- Enterococcus faecalis, a gut organism, can cause infective endocarditis.
- Occult colorectal pathology, like cecal carcinoma, can be an unusual source for enterococcal endocarditis.
- The case demonstrates a link between appendiceal obstruction/infection due to cecal carcinoma and subsequent endocarditis.
Implications:
- Enterococcal endocarditis without a clear source warrants a thorough investigation for underlying colorectal pathology.
- Early detection of occult colorectal diseases may prevent severe complications like infective endocarditis.
- This case expands the understanding of Enterococcus faecalis as a cause of endocarditis originating from gastrointestinal malignancies.