Streptococcus bovis endocarditis with vertebral osteomyelitis, spondylodiscitis, meningitis and colonic carcinoma in a 72-year-old man presenting with neck pain

Abstract

A 72-year-old man presented with acute neck pain on top of a background of chronic ill health, weakness, intermittent night sweats and progressive weight loss. Vertebral osteomyelitis and spondylodiscitis of the cervical spine as well as meningitis were diagnosed after some delay. Streptococcus bovis endocarditis was later diagnosed as the source of septic emboli to the bones and meninges. Further workup uncovered carcinoma of the colon. He was successfully treated with good functional outcome at one year. The atypical presentation of infective endocarditis in old age and the association between Streptococcus bovis and colonic carcinoma were reviewed and discussed. This is the fourth known case of vertebral osteomyelitis and eighth report of acute spondylodiscitis complicating S. bovis endocarditis. We recommend that patients presenting with new back pain in the absence of previous injury, local spinal tenderness, fever, and heart murmur be evaluated for infective endocarditis and vertebral osteomyelitis/spondylodiscitis. If Streptococcus bovis endocarditis is diagnosed, then a workup for colonic lesion, especially carcinoma, should be done.