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S. gallolyticus Endocarditis — EECC MCQ

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ModerateValvular Heart DiseaseS. gallolyticus EndocarditisEECC

A 62-year-old man presents with fever, weight loss, and splinter haemorrhages. Transthoracic echocardiography shows a possible 5 mm vegetation on the aortic valve. Two sets of blood cultures are positive for Streptococcus gallolyticus (bovis). Which additional investigation is specifically recommended in the context of this organism?

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Correct answer: D — Colonoscopy

Streptococcus gallolyticus (formerly S. bovis biotype I) bacteraemia and endocarditis have a well-established association with colonic neoplasia (adenomas and carcinomas). The ESC IE Guidelines recommend colonoscopy in all patients with S. gallolyticus/bovis endocarditis to screen for colorectal malignancy, even in the absence of gastrointestinal symptoms. The prevalence of colonic neoplasia in these patients is approximately 25-50%. PET-CT may be useful for identifying embolic complications or metastatic infection but does not specifically address the organism-neoplasia link.

Reference: ESC (2023): Guidelines on Infective Endocarditis