Nemoto Takaaki, Kunishima Hiroyuki, Hirose Masanori, Yamasaki Yukitaka, Torikai Keito, Nishisako Hisashi, Takagi Taeko, Fujitani Shigeki, Matsuda Takahide
Kansenshogaku Zasshi. 2014 Jul;88(4):474-7. doi: 10.11150/kansenshogakuzasshi.88.474.
An 80-year-old Japanese man had a fall presented with a 3-week history of right lumbago exacerbated by body movement as well as a 1-week history of anomalous behavior and appetite loss. He visited our hospital complaining of difficulty in standing up. He had a history of mitral prolapse due to an unknown rupture of the chordae tendineae 3 years earlier, which resulted in moderate mitral valve regurgitation and atrial fibrillation. Upon visiting the hospital, he had petechial hemorrhage and jaundice of the conjunctiva, a systolic murmur (Levine II/VI) at the apex and 4th interspace of the left sternal border, and a positive right straight leg raising test result. Moderate bilirubinemia and disseminated intravascular coagulation which were considered to have been produced secondarily were observed. Infective endocarditis was suspected, and 3 sets of blood culture were extracted. The patient was admitted on the same day. Blood cultures were positive for Streptococcus gallolyticus subsp. gallolyticus (6/6) on the following day. Transesophagela echocardiography was carried out on the same day, and vegetation with a diameter of 4mm was observed in the anterior mitral leaflet; the patient was subsequently diagnosed as having infective endocarditis. Colonic endoscopy was performed after hospitalization. Twelve colonic adenomata were found, and endoscopic mucosal resection was performed on one polyp. The bacterium found in the culture was classified as Streptococcus bovis type I, which causes infective endocarditis and bacteremia. Furthermore, this bacteria is a relatively rare causative organism of infective endocarditis. Tolerance to macrolide and tetracycline are reported in the literature. Moreover, the cell wall of this bacterium may have low pathogenicity as well as cause chronic inflammation in the large intestine mucous membrane, colonic polyps, and colorectal cancer. Several colonic adenomata and a partial shift to a malignant pathology were observed in this case. When this bacterium is detected, searching for a pathological change in the large intestine is believed to be indispensable.
一名80岁的日本男性因跌倒前来就诊，他有3周的右侧腰痛病史，身体活动会使其加重，还有1周的行为异常和食欲减退病史。他因站立困难前来我院就诊。3年前，他因不明原因的腱索断裂患有二尖瓣脱垂，导致中度二尖瓣反流和心房颤动。就诊时，他有结膜瘀点出血和黄疸，在心尖和左胸骨缘第4肋间有收缩期杂音（Levine II/VI级），右侧直腿抬高试验结果为阳性。观察到中度胆红素血症和继发性弥散性血管内凝血。怀疑为感染性心内膜炎，采集了3套血培养样本。患者于同日入院。次日，血培养结果显示解脲链球菌亚种解脲链球菌阳性（6/6）。同日进行了经食管超声心动图检查，在前叶二尖瓣上观察到直径为4mm的赘生物；患者随后被诊断为感染性心内膜炎。住院后进行了结肠内镜检查。发现了12个结肠腺瘤，并对其中一个息肉进行了内镜黏膜切除术。培养中发现的细菌被分类为I型牛链球菌，可引起感染性心内膜炎和菌血症。此外，这种细菌是感染性心内膜炎相对罕见的病原体。文献报道其对大环内酯类和四环素类耐药。而且，这种细菌的细胞壁可能致病性较低，但会导致大肠黏膜、结肠息肉和结直肠癌的慢性炎症。该病例中观察到多个结肠腺瘤和部分病理转变为恶性。当检测到这种细菌时，认为对大肠进行病理检查是必不可少的。
