title: Colonoscopy is mandatory after Streptococcus bovis endocarditis: a lesson still not learned. Case report.
abstract: BACKGROUND
  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.
  
  
  METHODS
  We 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.
  
  
  CONCLUSIONS
  As 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.
authors.affiliation: Department of Surgery, University of Pavia, Istituto di Chirurgia Epatopancreatica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. albertaferrari@libero.it
authors.forename: Alberta
authors.initials: A
authors.lastname: Ferrari
authors.forename: Ivan
authors.initials: I
authors.lastname: Botrugno
authors.forename: Elisa
authors.initials: E
authors.lastname: Bombelli
authors.forename: Tommaso
authors.initials: T
authors.lastname: Dominioni
authors.forename: Emma
authors.initials: E
authors.lastname: Cavazzi
authors.forename: Paolo
authors.initials: P
authors.lastname: Dionigi
mesh_terms: D003106:Colon / Q000382:microbiology; D003110:Colonic Neoplasms / Q000175:diagnosis*; D003113:Colonoscopy; D004697:Endocarditis, Bacterial / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013290:Streptococcal Infections / Q000209:etiology*; D016985:Streptococcus bovis