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Streptococcus gallolyticus  subspecies (subsp.)  gallolyticus  (formerly  bovis  biotype I) bacteremia has been associated with colonic adenocarcinoma. The  bovis  species underwent reclassification in 2003. Subtypes of  gallolyticus  are associated with colonic malignancy but are less frequent, resulting in less awareness. A 71-year-old male admitted with worsening lower back pain and fevers. Initial vital signs and laboratory data were within normal limits. MRI revealed lumbosacral osteomyelitis and antibiotics were initiated. Blood cultures showed  Streptococcus  species, prompting a transesophageal echocardiogram (TEE) revealing vegetations on the mitral and aortic valves. The etiology for his endocarditis was unclear. A colonoscopy was suggested, but his clinical instability made such a procedure intolerable. Final cultures revealed  Streptococcus gallolyticus  subsp.  pasteurianus  (previously  bovis  biotype II). After antibiotic completion he underwent aortic grafting with valve replacements. Later, he was readmitted for  Streptococcus  bacteremia. After a negative TEE, colonoscopy revealed a 2.5 × 3 cm cecal tubulovillous adenoma with high-grade dysplasia suspicious for his origin of infection. Clinicians understand the link between  Streptococcus gallolyticus  subsp.  gallolyticus  ( bovis  type I) and malignancy, but the new speciation may be unfamiliar. There are no guidelines for managing  S. gallolyticus  subsp.  pasteurianus  bacteremia; therefore a colonoscopy should be considered when no source is identified.

case reports in gastrointestinal medicine

The Association of<i>Streptococcus gallolyticus</i>Subspecies<i>pasteurianus</i>Bacteremia with the Detection of Premalignant and Malignant Colonic Lesions

The Association ofStreptococcus gallolyticusSubspeciespasteurianusBacteremia with the Detection of Premalignant and Malignant Colonic Lesions