3066 Recurrent Streptococcus bovis Bacteremia in the Absence of Colonic Neoplasm

Abstract

INTRODUCTION: Associations between Streptococcus bovis (S. bovis) bacteremia and colorectal cancers and colonic adenomas have been reported in the medical literature since the 1970's. We are reporting an extremely rare case of recurrent Streptococcus bovis biotype II bacteremia in the absence of colonic neoplasm. CASE DESCRIPTION/METHODS: 53-year-old man with diffuse large B-cell lymphoma – in remission (treated with chemotherapy and autologous stem cell transplantation), nesidioblastosis (treated with partial pancreatectomy/splenectomy) and hypertension was admitted to the hospital with severe sepsis. Of note, one month prior to his presentation, he was admitted to the hospital for S. bovis bacteremia. Examination: temperature 37.8°C, HR 104/minute, respiratory rate 28/minute, BP 101/51 mmHg and Spo2 98% on 4 liters nasal cannula. Laboratory data: white cell count 32.83 × 103/μL, hemoglobin 13.0 g/dL, platelets 210 × 103/μL, sodium 139 mEq/L, potassium 3.2 mEq/L, chloride 95 mEq/L, bicarbonate 22.6 mEq/L, creatinine 1.3 mg/dL, AST 124 IU/L, ALT 152 IU/L, alkaline phosphatase 139 IU/L, total bilirubin 0.3 mg/dL, lactic acid 6.6 mmol/L. Blood culture – positive for S. bovis. Infective endocarditis was ruled out by an echocardiogram. Patient was given intravenous antibiotic therapy and follow up blood cultures did not demonstrate any growth. Due to the association between S. bovis bacteremia and colonic malignancy, colonoscopy was performed. Patient was found to have a small, hyperplastic polyp in the cecum and diverticulosis involving the ascending, sigmoid and descending colon. DISCUSSION: S. bovis is a rare cause of bacteremia accounting for <1% of blood culture isolates. It has a high mortality rate of 26-70% and has been associated with colorectal malignancy, endocarditis, and hepatic dysfunction. There are two S. bovis biotypes (I and II) and the prevalence of colorectal neoplasm in patients with S. bovis biotype II bacteremia (23%) is substantially lower than biotype I (70%). Our patient had S. bovis biotype II bacteremia and did not have evidence of malignancy/adenoma(s) in the colonoscopy. To our knowledge this is the first case of recurrent S. bovis bacteremia reported in the medical literature in the absence of both colorectal cancer and colonic adenoma.