Bacteroides fragilis endocarditis in a patient with Crohn's disease.

Bacteroides fragilis is an uncommon cause of endocarditis and its occurrence in Crohn's disease has never been reported. We present a case of a B fragilis bacteraemia and endocarditis caused by seeding of left ventricular thrombus formed secondary to severe left ventricular dysfunction. A 44-years-old man with a history of persistent bloody diarrhoea for many years presented with 1-month duration of generalised weakness, malaise, fever and chills. The patient also developed right foot pain associated with cyanotic discolouration. On examination, he was cachectic and his right foot was pulseless, cold and blue in colour. Echocardiogram showed three intraventricular echo densities. Colonoscopy revealed multiple fistulous openings and blood cultures grew B fragilis. He was treated with intravenous metronidazole and underwent a proctocolectomy with ileostomy. Biopsy of the specimen confirmed Crohn's disease. This case emphasises the importance of identifying anaerobic bacteria as an uncommon but important cause of endocarditis and recognise likely source.