A novel source of enterococcal endocarditis.

An important element of the evaluation of patients with infective endocarditis is the determination of an infectious source. In approximately 20-45% of cases, no source is identified. Often the specific organism involved implicates the source, as is classically described by the association of S. bovis with colonic neoplasia. Other gut organisms have been reported to infect heart valves when colorectal pathology is present, but at far less frequency than S. bovis. This report deals with the case of a 75-year-old man with Enterococcus faecalis endocarditis of an unusual source--a cecal carcinoma that was causing intermittent appendiceal obstruction and infection. This case adds to previous case reports which suggest that the occurrence of enterococcal endocarditis in the absence of a classic infectious source should lead to a search for occult colorectal pathology.