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A 49-year-old male presents with fever, weight - highsky
#1


A 49-year-old male presents with fever, weight loss and anorexia for the last three weeks. Fever is not associated with rigors, chills or sweating. The patient also reports muscle aches and pain. He has a thirty pack year history of cigarette smoking. On examination, a murmur is audible, best heard in the aortic area, that accentuates with expiration. Blood cultures are taken and empiric antibiotics are started. Blood cultures reveal Streptococcus bovis. Other than antibiotic treatment, which further step is recommended in this patient?


A. Cystoscopy
B. Colonoscopy
C. Bronchoscopy
D. 3 Consecutive stool samples
E. Chest x-ray
F. CT scan of the head
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#2
BBB,
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#3
bbb
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#4
This patient presents with infective endocarditis of the aortic valve due to Streptococcus bovis. Patients with Streptococcus bovis endocarditis or septicemia are at high risk for the development of occult colorectal cancer, or upper GI cancer. The reason for the increased incidence of GI malignancy in these patients is unknown. These patients need to be evaluated endoscopically or radiographically. Stool samples are not the appropriate choice here.

The above patient has a history of cigarette smoking which puts him at an increased risk for bronchogenic carcinoma; however, chest x-ray or bronchoscopy is not a useful screening tool for this purpose. Currently, there is no useful tool for screening of lung cancer in the general population or in high-risk patients. Streptococcus bovis infection is not associated with lung cancer.

Cigarette smoking is a risk factor for carcinoma of bladder; however, cystoscopy is not needed here, as the above patient does not have any symptoms of bladder cancer. Streptococcus bovis infection is not associated with bladder cancer.

Educational Objective:
Streptococcus bovis endocarditis is associated with colorectal cancer and colonoscopy is advisable in such patients.
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