SHM Converge Scientific Abstract ePoster Gallery-Streptococcus Equinus (Bovis Group) Sepsis With Endocarditis in a Patient With Tavr

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A 71-year-old man with coronary artery disease, ankylosing spondylitis, and prior transcatheter aortic valve replacement (TAVR) presented with 3 days of fever, tachycardia, severe generalized weakness, and 3 weeks of myalgias and fatigue. He was SARS-CoV-2 positive, but initial chest X-ray and labs were otherwise non-specific. Blood cultures grew Streptococcus equinus (S. bovis group), a pathogen strongly associated with infective endocarditis and colorectal malignancy.<br /><br />He was started on remdesivir for COVID-19 and then ceftriaxone after cultures resulted. Although transthoracic and transesophageal echocardiography were negative, FDG-PET/CT showed diffuse uptake around the prosthetic valve, confirming prosthetic valve endocarditis. Blood cultures cleared within 48 hours of ceftriaxone. He was discharged on a 6-month antibiotic course, later switched to levofloxacin because of ceftriaxone-induced neutropenia. Follow-up surveillance cultures remained negative after stopping antibiotics.<br /><br />Because S. bovis group bacteremia is linked to colon neoplasia, colonoscopy was performed and found a 20 mm rectal lesion with high-grade dysplasia plus three additional adenomatous polyps; all were endoscopically resected. Ongoing surveillance was planned, and first-degree relatives were advised to begin colorectal screening early.<br /><br />This case highlights several key lessons: prosthetic valve endocarditis can be present despite negative echocardiography; FDG-PET/CT is valuable when suspicion remains high; and S. equinus bacteremia should prompt evaluation for both endocarditis and colorectal cancer. The initial positive COVID-19 test also risked diagnostic anchoring, emphasizing the need for continued clinical vigilance.

Asset Subtitle

Robert Scheel

Meta Tag

Author List Gretchen A. Colbenson, Lindsay Howlett, Robert Scheel

Category Clinical Vignettes

Concept Streptococcus equinus

Concept Infective Endocarditis

Concept Prosthetic valve endocarditis

Concept Bacteremia

Concept Colorectal Neoplasia

Distinguished Finalist

Presenter Organization Mayo Clinic - Rochester

Presenting Author Robert Scheel

Track Adult

Keywords

Streptococcus equinus

prosthetic valve endocarditis

TAVR

FDG-PET/CT

S. bovis group

colorectal neoplasia

bacteremia

echocardiography negative

COVID-19 co-infection

colonoscopy

Streptococcus equinus

Infective Endocarditis

Prosthetic valve endocarditis

Bacteremia

Colorectal Neoplasia