Streptococcus sanguis endocarditis associated with colonic carcinoma

Abstract

Infective endocarditis caused by Streptococcus bovis is known to be associated with colorectal malignancy. Other less common streptococci, specifically Streptococcus sanguis, can be similarly associated with gastrointestinal carcinoma. We present a case of disseminated colorectal carcinoma occurring after a confirmed S sanguis endocarditis, that required mitral valve surgery. There may be a need for gastrointestinal surveillance in patients presenting with bacteraemia caused by less common streptococci.

Figure 1

Transoesophageal echocardiographic view showing a highly mobile vegetation suspended from a flail segment of the posterior mitral valve leaflet which prolapses back into the left atrium. Significant mitral regurgitation was evident on both colour flow and spectral Doppler imaging. AMVL, anterior mitral valve leaflet; LA, left atrium; LV, left ventricle; PMVL, posterior mitral valve leaflet; PM, papillary muscle; Veg, vegetation.

Figure 2

Endoscopy image showing a circumferential tumour at the hepatic flexure.