The Significance of Clinical Suspicion: From Pitting Edema to Streptococcus infantarius Endocarditis

As advancements in medicine progress, greater emphasis has been placed on laboratory values and imaging rather than the clinical picture. This, as a result, has led to a decline in the use of clinical history and physical examinations. In many instances, some details of the history are glossed over, and performing a physical examination has become more lackadaisical. Here, we would like to present a unique case of a patient who presented to the emergency department with only pitting edema that was worsening for the past few weeks. Vitals were noted to be unremarkable, and the rest of the physical examination only revealed mild ascites and a new heart murmur, which was not present in his previous documented clinic visits. Due to this concerning physical examination finding, a cardiology and hepatology workup was done. It was then revealed that the patient had severe aortic and mitral valve vegetation suggesting infective endocarditis with severe aortic insufficiency due to <i>Streptococcus infantarius</i>. Due to the bacterium being a member of the <i>Streptococcus bovis</i> species, a colonoscopy was done, which revealed multiple tubular adenomas. A discussion regarding <i>S. infantarius</i> will be held, as well as the unique details of tubular adenomas causing <i>S. infantarius</i> bacteremia. The importance of physical examination and clinical suspicion will also be discussed.