title: Streptococcus gallolyticus: a single bacteria, two different conditions.
abstract: The authors describe the case of a 48-year-old woman presenting with fever, joint pain and migratory skin lesions. She had no other symptoms or medical history. After an extensive and inconclusive work up, she was admitted to the hospital for further study. This patient was ultimately found to have Streptococcus gallolyticus subsp gallolyticus bacteraemia. This finding led to the diagnosis of mitral valve infective endocarditis related to an underlying rectum adenocarcinoma. This article points out diagnostic difficulties related to an unusual presentation of the underlying disease. Furthermore, the authors reinforce the need of keeping a high level of suspicion and a systematic approach in every case of fever of unknown origin. This case highlights the importance of performing a colonoscopy in the event of S. gallolyticus subsp gallolyticus bacteraemia, as it may provide an opportunity for detecting colonic lesions at an earlier stage.
authors.affiliation: Department of Internal Medicine, Centro Hospitalar de Lisboa Central, EPE-Hospital de Santa Marta, Lisbon, Portugal.
authors.forename: Cristiano Silva
authors.initials: CS
authors.lastname: Cruz
authors.affiliation: Department of Internal Medicine, Centro Hospitalar de Lisboa Central, EPE-Hospital de Santa Marta, Lisbon, Portugal Department of Internal Medicine, Hospital de Santo Espírito da Ilha Terceira, Angra do Heroísmo, Portugal.
authors.forename: Catarina
authors.initials: C
authors.lastname: Machado
authors.affiliation: Department of Internal Medicine, Centro Hospitalar de Lisboa Central, EPE-Hospital de Santa Marta, Lisbon, Portugal.
authors.forename: André
authors.initials: A
authors.lastname: Almeida
authors.affiliation: Department of Internal Medicine, Centro Hospitalar de Lisboa Central, EPE-Hospital de Santa Marta, Lisbon, Portugal.
authors.forename: Rita Barata
authors.initials: RB
authors.lastname: Moura
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004697:Endocarditis, Bacterial / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy; D006801:Humans; D008875:Middle Aged; D008943:Mitral Valve; D012004:Rectal Neoplasms / Q000150:complications / Q000175:diagnosis*; D013290:Streptococcal Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D016985:Streptococcus bovis; D016896:Treatment Outcome; D014463:Ultrasonography