Spondylodiscitis and Infective Endocarditis Caused by Streptococcus bovis in a Patient with Colon Cancer

Musculoskeletal symptoms are complaints especially common in the elderly. Similar symptoms also occur in patients with infective endocarditis; they are often treated as rheumatic or degenerative diseases. In patients with infective endocarditis, symptoms may also be complicated with vertebral osteomyelitis, especially streptococcal infective endocarditis. Literature review indicates that, in patients, especially the elderly who have bacteremia and/or endocarditis from Streptococcus bovis, investigation of colonic lesions is optimal. The study reports a 64-year-old male patient with initial presentation of exertional dyspnea. Bacteremia and endocarditis from S. bovis was diagnosed. Colonoscopy showed a colon cancer in early stage over cecum. The patient underwent right hemicolectomy and had new onset of severe low back pain during this period. Magnetic resonance imaging revealed spondylodiscitis over low lumbar spine. He underwent debridment and anterior interbody fusion. Under the cover of antibiotics, he recovered well. For patients, who have bacteremia and/or endocarditis from S. bovis, screening test should be arranged under the suspicion of colon lesion, especially in the elderly. Moreover, the musculoskeletal symptoms should be treated with care for the possibility of infection. (Taiwan Geriatr Gerontol 2009; 4(4): 274-281)