Background: Infective endocarditis with Enterococcus spp. is common in patients with digestive tract diseases. Such patients should be monitored periodically through clinical examination and colonoscopy, to detect the recurrence of seemingly cured disease. There are currently no studies on the incidence of infective endocarditis in patients with hemorrhoidal disease. Case report: The case of a 48-year-old man is addressed, known with type 2 diabetes mellitus, with a seemingly cured hemorrhoidal disease, who developed infective endocarditis of the mitral and aortic valve, complicated by ischemic stroke as the fi rst symptom. After six weeks of antibiotic treatment, an almost complete echocardiographic resolution of the vegetation was achieved, such that surgical intervention was postponed. Conclusion: Performing a colonoscopy in all Enterococcus spp. infective endocarditis patients, regardless of the presumed source of infection, could be helpful in diagnosing colorectal disease and avoiding a new bacteraemia episode - and eventually infective endocarditis - by the same or a different microorganism. The presented case emphasizes the importance of periodic monitoring of the digestive tract for hemorrhoidal disease in patients with a high risk of recurrence - due to high risk of bacteraemia and systemic complications. Moreover, it is worth noting that in certain cases, efficient antibiotic treatment on its own can achieve an outstanding result for patients with large vegetations, presenting with an embolic episode, and thus postpone (indefinitely) a surgical intervention.
Epidemiology and antibiotic treatment of infective endocarditis: an update
