title: Embolic stroke complicating Staphylococcus aureus endocarditis circumstantially linked to rectal trauma from foreign body: a first case report.
abstract: BACKGROUND
  Diagnostic and therapeutic instrumentation of the lower gastrointestinal tract has been reported to result in bacteremia and endocarditis. No such case has been reported in persons with a history of rectal foreign body insertion despite its potential for greater trauma.
  
  
  METHODS
  A 58-year-old male was admitted with confusion and inability to speak. His past history was notable for hospitalization to extract a retained plastic soda bottle from the rectosigmoid two years prior. On examination, he was febrile, tachycardic and hypotensive. There was an apical pansystolic murmur on cardiac examination. He had a mixed receptive and expressive aphasia, and a right hemiparesis. On rectal examination he had perianal erythema and diminished sphincter tone. Magnetic resonance imaging of the brain showed infarction of the occipital and frontal lobes. Transesophageal Echocardiography of the heart revealed vegetations on the mitral valve. All of his blood culture bottles grew methicillin sensitive Staphylococcus aureus. He was successfully treated for bacterial endocarditis with intravenous nafcillin and gentamicin. The rectum is frequently colonized by Staphylococcus aureus and trauma to its mucosa can lead to bacteremia and endocarditis with this organism. In the absence of corroborative evidence such as presented here, it is difficult to make a correlation between staphylococcal endocarditis and anorectal foreign body insertion due to patients being less than forthcoming
  
  
  CONCLUSIONS
  There is a potential risk of staphylococcal bacteremia and endocarditis with rectal foreign body insertion. Further studies are needed to explore this finding. Detailed sexual history and patient counseling should be made a part of routine primary care.
authors.affiliation: University of California, San Diego, USA. braj.pandey@med.va.gov
authors.forename: Braj B
authors.initials: BB
authors.lastname: Pandey
authors.forename: Tuan C
authors.initials: TC
authors.lastname: Dang
authors.forename: John F
authors.initials: JF
authors.lastname: Healy
mesh_terms: D004697:Endocarditis, Bacterial / Q000150:complications*; D005547:Foreign Bodies / Q000150:complications*; D006801:Humans; D020766:Intracranial Embolism / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000293:injuries*; D013203:Staphylococcal Infections / Q000150:complications*; D020521:Stroke / Q000150:complications* / Q000209:etiology*