Introduction Streptococcus gallolyticus belongs to the Streptococcus bovis complex, and it is a common bacterium colonizing the gastrointestinal tract. Its presence in the blood may suggest an underlying pathology such as a colonic neoplasm. We report herein a case of S. bovis bacteremia in an apheresis platelet donor, review similar cases in the literature, and suggest a flowchart for the management of similar cases in other blood donation centers. Case Presentation A 61-year-old subject presented to a Hemotherapy Service to make an apheresis platelet donation. On quality control testing, S. gallolyticus was identified in hemoculture, and the donor was called back for follow-up. At first, a new hemoculture was requested, and the patient was referred to the outpatient department of infectious diseases to further investigate pathologies associated with S. gallolyticus. A subsequent colonoscopy investigation evidenced a polypoid structure in the ascending colon. Pathology reported the resected specimen as a low-grade tubular adenoma. Conclusion Isolation of S. bovis in blood products requires further investigation and should be managed with precision by Hemotherapy Services. A standard protocol for the management of asymptomatic patients with S. bovis positive hemoculture, with the requests of a new blood culture, a colonoscopy, and an echocardiogram is crucial, as it may ensure early diagnosis and reduce morbidity and mortality.
A 44-year-old woman presents with icterus, abdominal pain, nausea, and fever. On examination, the vital signs were normal. The abdomen was soft, with moderate tenderness in the right upper quadrant. Blood tests showed a normal white cell count (6,290 per mm 3 ) with eosinophilia (22%) and increased levels of total bilirubin (4.8 mg/dL), alkaline phosphatase (132 U/L), and alanine aminotransferase (101 U/L). The magnetic resonance cholangiopancreatography showed an enlarged common bile duct (1.1 cm), containing hypointense and heterogeneous material, suggestive of choledocholithiasis (Figure 1). The patient underwent an endoscopic retrograde cholangiopancreatography, which demonstrated radiolucent filling defects into the common bile duct (Figure 1). After sphincterotomy, the endoscopist observed the drainage of several live larvae from the biliary duct, similar to slugs (Figure 2). Fecal analysis confirmed the presence of eggs of Fasciola sp. On further history, the patient was discovered to be a nutritionist, reporting regular consumption of watercress, the likely source of fascioliasis. She was treated with triclabendazole for 2 days with prompt recovery. Figure 1. (A) Magnetic resonance cholangiopancreatography showing a hypointense filling defect (white arrow) into the distal part of the common bile duct, mimicking a gallstone. (B) Endoscopic retrograde cholangiopancreatography showing dilatation of the common bile duct, with radiolucent filling defects.
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