Clinical Images  |   January 2019
Streptococcus gallolyticus Group Bacteremia and Colonic Adenocarcinoma
Author Notes
  • From the Department of Internal Medicine at UConn Health in Farmington, Connecticut (Drs McAuliffe and Cox), and the Department of Pathology at Hartford Hospital in Connecticut (Dr Bhat). 
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  *Address correspondence to Agnes McAuliffe, DO, Department of Internal Medicine, UConn Health, 263 Farmington Ave, Farmington CT, 06030-0002. Email: amcauliffe@uchc.edu
     
Article Information
Gastroenterology / Imaging / Clinical Images
Clinical Images   |   January 2019
Streptococcus gallolyticus Group Bacteremia and Colonic Adenocarcinoma
The Journal of the American Osteopathic Association, January 2019, Vol. 119, 65. doi:https://doi.org/10.7556/jaoa.2019.011
The Journal of the American Osteopathic Association, January 2019, Vol. 119, 65. doi:https://doi.org/10.7556/jaoa.2019.011
A 76-year-old woman presented to the emergency department with a fever (38.9°C), vomiting, and diarrhea of 2 days’ duration. The patient's medical history included coronary artery disease, stroke, hypertrophic cardiomyopathy, diastolic heart failure, hypertension, and end-stage renal disease, for which she received dialysis. She had no personal or family history of colon cancer. Blood cultures demonstrated growth of Streptococcus gallolyticus (formerly known as Streptococcus bovis) group bacteremia. A transesophageal echocardiogram did not show valvular vegetation. Colonoscopy results revealed a nonobstructing, fungating mass in the distal rectum (image A). Histologic evaluation confirmed low-grade rectal adenocarcinoma with submucosal invasion (image B). The patient was treated with 2 g of intravenous ceftriaxone daily, as the minimal inhibitory concentration to penicillin was 0.10 μg/mL. This regimen was changed to 2 g of cefazolin 3 times per week after dialysis when she was discharged to an acute rehabilitation center for a total of 4 weeks of therapy. She underwent transanal excision of her colonic mass and did not require further radiation or chemotherapy. 

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