Differential Diagnosis for Recurrent Strep Gallolyticus Bacteremia
Single Most Likely Diagnosis
- Colorectal Cancer: Strep gallolyticus (formerly known as Streptococcus bovis biotype I) bacteremia is strongly associated with colorectal cancer. The bacterium is commonly found in the gastrointestinal tract, and its presence in the bloodstream often indicates a breach in the intestinal mucosa, such as that caused by a tumor.
Other Likely Diagnoses
- Diverticulitis: Inflammation of the diverticula in the colon can provide a portal of entry for Strep gallolyticus into the bloodstream.
- Gastrointestinal Ulcer or Perforation: Similar to diverticulitis, ulcers or perforations in the gastrointestinal tract can allow bacteria to enter the bloodstream.
- Liver Abscess or Cholangitis: Given the patient's history of liver cirrhosis, an abscess or cholangitis could be a source of recurrent bacteremia, especially if there is a biliary obstruction or other complication.
Do Not Miss Diagnoses
- Endocarditis: Although less common, Strep gallolyticus can cause endocarditis, which is a life-threatening condition if not promptly treated.
- Intra-abdominal Abscess: An abscess in the abdominal cavity could be a source of recurrent bacteremia and requires urgent attention to prevent sepsis and other complications.
Rare Diagnoses
- Biliary Tract Cancer: While less common than colorectal cancer, biliary tract cancers (such as cholangiocarcinoma) could potentially be a source of Strep gallolyticus bacteremia.
- Gastrointestinal Lymphoma: Certain types of lymphoma affecting the gastrointestinal tract could lead to bacteremia, although this would be a rare cause.