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Streptococcus gallolyticus endocarditis — ABIM Board MCQ

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ModerateCardiovascularStreptococcus gallolyticus endocarditisABIM Board

A 61-year-old is completing treatment for Streptococcus gallolyticus native-valve endocarditis. Blood cultures have cleared, echocardiography shows no abscess and he has never undergone colorectal cancer screening. Which evaluation should be arranged after stabilization?

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Correct answer: B — Arrange colonoscopy to evaluate for colorectal neoplasia

The best answer is “Arrange colonoscopy to evaluate for colorectal neoplasia”. S. gallolyticus bacteremia and endocarditis have a clinically important association with colorectal adenomas and cancer, so colonoscopic evaluation is indicated. This does not imply a need for splenectomy, chest CT or lifelong suppressive antibiotics after otherwise successful native-valve treatment.

Reference: AHA Scientific Statement on Infective Endocarditis in Adults: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000296