Familial Adenomatous Polyposis Manifesting asLactococcusEndocarditis: A Case Report and Review of the Association ofLactococcuswith Underlying Gastrointestinal Disease

Abstract

A 45-year-old male with a prosthetic aortic valve presented to the hospital with several months of generalized malaise. On admission, he was noted to have anemia of unclear etiology and subsequently became febrile with multiple blood cultures growing Lactococcus garvieae. Inpatient workup was concerning for infectious endocarditis (IE) secondary to Lactococcus. The patient was discharged home with appropriate antimicrobial therapy; however, he was readmitted for persistent, symptomatic anemia and underwent colonoscopy, which revealed innumerable colonic polyps consistent with Familial Adenomatous Polyposis (FAP) that was later confirmed with genetic testing. Surveillance computed tomography (CT) imaging of the aortic repair later demonstrated valve dehiscence with surrounding fluid collection; he underwent redo surgery and was found to have destruction of the aortic annulus and a large pseudoaneurysm. Histopathology of the valve prosthesis confirmed IE. It is suspected that the patient developed Lactococcus IE from enteric translocation. Review of the literature provides several reports of Lactococcus infections in association with underlying gastrointestinal disease, including colorectal cancer. Given this association, we raise the question of whether the diagnosis of Lactococcus IE should evoke suspicion and encourage evaluation for gastrointestinal pathology, as occurs with Streptococcus bovis.

A curious case of Lactococcus garvieae bacteremia associated with adenocarcinoma

“…Our literature review points towards some similarities among patient cases infected by L. garvieae . Although many cases had presented as infective endocarditis, abscesses of the liver, spondylitis, peritonitis, diverticulitis, urinary tract infections, or multiorgan dysfunction, most of the cases involved bacteremia [7] , [8] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] . The published data most likely underestimates the prevalence and incidence of disease caused by L. garvieae due to misidentification with Enterococcus species.…”

“…Upon discharge, the patient was scheduled for a PET scan with further treatment recommendations to be provided based on imaging results. In view of the L. garvieae bacteremia, an outpatient colonoscopy was scheduled to rule out colon cancer, as the patient had never been scoped, and the organism had been reported in numerous patients with occult colon cancer [5] , [6] , [7] , [8] . However, shortly after being discharged to complete antibiotics outpatient, the patient unfortunately and unexpectedly passed away from unrelated causes before further workup could be obtained.…”

Lactococcus garvieae Endocarditis in a Prosthetic Aortic Valve: A Case Report and Literature Review

“…Abbreviations: NAV, native aortic valve; VAN, vancomycin; NMV, native mitral valve; AMX, amoxicillin; GEN, gentamicin; GD, gastrointestinal disorder; PMV, prosthetic mitral valve; RF, raw fish; AMP, ampicillin; CTX, ceftriaxone; CLX, cloxacillin; PAV, prosthetic aortic valve; PEN, penicillin; TOB, tobramycin; Pip/Taz, piperacillin/tazobactam; RI, rifampicin; TEI, teicoplanin; PTV, prosthetic tricuspid valve; LEV, levofloxacin. 1,6,8,12,13,17,18,21,22,25-39 …”

“…Our patient was immunocompromised and had a postoperative ileus 1½ years ago and colorectal cancer, which could have facilitated the infection, together with the predisposing 1,6,8,12,13,17,18,21,22,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] factor of a biological prosthetic valve. However, he denied eating raw fish in the last couple of weeks prior to admission to the hospital.…”

Familial Adenomatous Polyposis and Desmoid Tumor Treated with Multivisceral Transplantation and Kidney Autotransplantation: Case Report and Literature Review

“…Approximately 12% of FAP patients develop these palpable solid masses. They occur most commonly in the intra-abdominal cavity, abdominal wall, or mesenteric region [2]. DT are benign, though locally invasive, unpredictable, and sometimes life threatening [3,4].…”