Purpose: An 85-year-old Caucasian male was admitted for evaluation of lower thoracic back pain. The pain started 3 weeks prior to admission. Associated symptoms included low-grade fever, 5 pound weight loss, and anorexia. Past medical history was significant for recent myocardial infarction s/p stents, BPH, glaucoma, and a distant history of surgery for hyperparathyroidism. On physical exam he was afebrile (98.4 F) with a blood pressure of 128/78 and heart rate of 80 bpm. Pertinent positives included a holosystolic murmur at the apex and moderate point tenderness of T9 and T10 without any bony abnormalities or fluctuant areas. Abdomen was soft, non-tender, with normal bowel sounds, and no hepatosplenomegaly. Rectal exam revealed brown heme-negative stool with no palpable masses. Blood cultures from admission grew Streptococcus bovis (S. bovis) with intermediate susceptibility to penicillin. CT scan of the thoracic spine revealed a moth-eaten appearance of endplates and perivertebral soft tissue consistent with discitis and vertebral osteomyelitis. A fine needle aspiration biopsy of T9-T10 was negative for malignant cells and aspirate culture was also negative. A TEE was done, revealing severe myxomatous degeneration of the mitral valve with severe mitral regurgitation and a 0.5 cm mobile echo-dense lesion on the posterior leaflet. This could have been a calcified chord but vegetation could not be ruled out. A colonoscopy showed a 2 × 2 cm lobulated mass on a thick (> 2 cm) stalk in the mid-descending colon, as well as a 1.5 cm pedunculated polyp in the sigmoid colon. Pathology of the polyp revealed a tubular adenoma with high-grade dysplasia and adenomatous epithelium at the cauterized margins. Histology from the mass showed tubular adenomatous fragments without any high-grade dysplasia or carcinoma. Subsequent hemicolectomy revealed a 2 × 1.5 × 0.8 cm pedunculated nodular polyp on a soft stalk in the proximal descending colon. Pathology was negative for dysplasia and carcinoma. Eight of eight lymph nodes were also negative for malignancy. The patient ultimately completed a six-week course of intravenous ceftriaxone for vertebral osteomyelitis with improvement of back pain. The patient remained symptom free at the 6 month follow-up. In the last 10 years, there have been no documented cases of S. bovis endocarditis in association with vertebral osteomyelitis. We describe a unique case of an adenomatous polyp of the colon with high-grade dysplasia with possible S. bovis endocarditis presenting as vertebral osteomyelitis.