A 48-year-old male presents with persistent fever and a new regurgitant heart murmur. Blood cultures grow Streptococcus gallolyticus (formerly S. bovis). In addition to echocardiography and antibiotics, what essential evaluation is indicated?
Answer and explanation
Correct answer: A. Complete diagnostic colonoscopy to screen for colorectal neoplasia
- Step 1: Streptococcus gallolyticus bacteremia and endocarditis have a strong, proven association with underlying occult colorectal adenomas and carcinomas.
- Step 2: Translocation of the organism occurs through compromised colonic mucosal integrity.
- Step 3: A full screening colonoscopy is mandatory in all patients with S. gallolyticus endocarditis.
Answer
Complete diagnostic colonoscopy to screen for colorectal neoplasia.
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