Septic arthritis due to Streptococcus bovis as presenting sign of ‘silent’ colon carcinoma

C. García-Porrúa, M. A. González-Gay, J. R. Monterroso, A. Sánchez-Andrade and A. González-Ramirez1

1 Rheumatology and Gastroenterology Divisions, Hospital-Xeral Calde, 27004, Lugo, Spain

Sir, The association of Streptococcus bovis septicaemia and colon carcinoma has been described> [1]. However, septic arthritis due to S. bovis is uncommon [2, 3] and its occurrence as an alarm sign for the presence of ‘silent’ colonic neoplasm has not been previously reported.

A 58-yr-old male presented at the hospital because of pain and swelling of 3 days' duration in his left knee. He denied injury or previous history of arthritis. At the age of 18 yr he had started excessive alcohol intake and since then he had persisted in consuming at least 100 g/ethanol/day. On examination his temperature was 38.5°C. Severe synovitis in his left knee, parotid enlargement, cutaneous arterial ‘spiders’, angiomas, and tender hepatomegaly were observed. Full blood cell count disclosed 3800 leucocytes/mm3, 80 000 platelets/mm3 and macrocytosis without anaemia. The erythrocyte sedimentation rate was 98 mm/1st h. Coagulation tests showed a prolonged serum prothrombin time. Also, mild hypoalbuminaemia and hyponatraemia and abnormal hepatic function tests were found. Arthrocentesis yielded 60 ml of an inflammatory liquid [64 700 leucocytes/mm3 with 98% polymorphonuclear cells, glucose 60 mg/dl (serum glucose 108 mg/dl) and absence of microcrystals]. Empirical treatment with ceftriaxone 2 g intravenous (i.v.) was started and maintained when growth of streptococcus was confirmed from blood and synovial fluid cultures. Closed needle drainage of the left knee was performed twice daily. As fever, malaise and clinical evidence of effusion had not improved after a week of treatment, open drainage of the knee was performed. Subsequently, progressive improvement was observed and antibiotic therapy was discontinued 2 weeks later. Transthoracic and transoesophageal echocardiogram yielded no data of endocarditis. However, a pancolonic colonoscopy showed a polypoid colonic adenocarcinoma confined to the bowel wall of the sigmoid colon. Thoracic and abdominal computed tomography showed liver and spleen enlargement without evidence of metastasis. Colectomy was performed.

Streptococcus bovis, a non-enterococcal group D streptococcus, is a cause of septicaemia and endocarditis [4], infections of the central nervous system and lateral neck abscesses [5, 6]. However, only two cases of peripheral monoarthritis have been described [2, 3] and neither was associated with colon cancer. Our patient was an alcoholic which also put him at risk of ‘bizarre’ sepsis. As reported in cases of bacteraemia due to S. bovis, routine screening for colonic tumour was performed [7, 8]. This case suggests that, regardless of the absence of endocarditis, septic arthritis due to S. bovis should lead to further evaluations to exclude possible occult colonic tumour.

Notes

Correspondence to: M. A. González-Gay. Back

References

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  7. Zarkin BA, Lillemoe KD, Cameron JL, Effron PN, Magnuson TH, Pitt HA. The triad of Streptococcus bovis bacteremia, colonic pathology, and liver disease. Ann Surg1990;211:791–2.
  8. Dao T, Jardin-Grimaux I, Vergnaud M et al. Prospective study of routine screening for cirrhosis and colonic tumors associated with Streptococcus bovis bacteremia (in French). Gastroenterol Clin Biol1991;15:311–4.[ISI][Medline]
Accepted 8 October 1999





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