Abstract
BackgroundEven though the relationship between certain bacterial infections and neoplastic lesions of the colon is well-recognized, this knowledge has not been sufficiently translated into routine practice yet.Case presentationWe describe the case of a 51-year-old man who was admitted to our Surgical Department due to rectal bleeding and abdominal pain. Preoperative colonoscopy, staging exams and subsequent surgery demonstrated a stenotic adenocarcinoma of the sigmoid colon, invading the left urinary tract and the homolateral bladder wall, with regional lymph nodes involvement and massive bilobar liver metastases (T4N1M1). After Hartmann's rectosigmoidectomy and despite systemic chemotherapy, a rapid progression occurred and the patient survived for only 5 months after diagnosis. Five years before detecting this advanced colonic cancer, the patient underwent aortic valve replacement due to a severe Streptococcus bovis endocarditis. Subsequent to this infection he never underwent a colonoscopy until overt intestinal symptoms appeared.ConclusionAs this case illustrates, in the unusual setting of a Streptococcus bovis infection, it is necessary to timely and carefully rule out occult colon cancer and other malignancies during hospitalization and, if a tumor is not found, to schedule endoscopic follow-up. Rigorous application of these recommendations in the case described would have likely led to an earlier diagnosis of cancer and maybe saved the patient's life.
Highlights
ConclusionIn the unusual setting of a Streptococcus bovis infection, it is necessary to timely and carefully rule out occult colon cancer and other malignancies during hospitalization and, if a tumor is not found, to schedule endoscopic follow-up
Even though the relationship between certain bacterial infections and neoplastic lesions of the colon is well-recognized, this knowledge has not been sufficiently translated into routine practice yet.Case presentation: We describe the case of a 51-year-old man who was admitted to our Surgical Department due to rectal bleeding and abdominal pain
We report the case of a patient who was diagnosed with a very advanced colonic cancer five years after a severe Streptococcus bovis endocarditis
Summary
In the unusual setting of a Streptococcus bovis infection, this case stresses the need to timely and carefully rule out occult colon cancer and other malignancies during hospitalization and, if a tumor is not found, to schedule an annual endoscopic follow-up. Even though it is already well-recognized that the clinical setting of a Streptococcus bovis (or gallolyticus) infection mandates a diagnostic work-up to reveal an occult neoplasia, it seems that awareness among physicians who take care of these patients is still poor, due to the pitfall of nomenclature. Gold et al have warned about the underutilization of colonoscopy in their patient population with Streptococcus bovis bacteremia [17] and Wentling
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