Infective endocarditis as possible complication of endoscopic stricture dilation in Crohn's disease

Aims Infective endocarditis is one of the rarest complications of endoscopic procedures.

Methods The authors present a case present a case of an infective endocarditis following a dilation of a Crohn-related intestinal stricture [1] [2] [3].

Results 61-year-old male patient was admitted twice in a month in our hospital because of Crohn’s disease exacerbation with intestinal sub-occlusion. He had a 30-year history of ileocolonic Crohn’s disease (Montreal score A2L3B2) and aortic insufficiency with implantation of biological aortic prosthesis. The patient improved only with conservative management. He was previously treated with long-term maintenance therapy with azathioprine 200 mg/day and Infliximab 5 mg/kg (8/8 weeks). Serum Infliximab levels were at the therapeutic range and anti-infliximab antibodies were absent. His last MRI described a 4 cm long sigmoid colon’s fibrotic stenosis. Following the last admission an elective TTS endoscopic balloon dilation of the sigmoid colon stenosis was performed. At the time of the procedure, the patient was not on any corticosteroid therapy and no prophylactic antibiotic was given. A first dilation up to 10 mm followed by another (after 4 weeks) up to 12 mm were performed without immediate complications. One month later, because of a history of a persistently feverish syndrome, he was referred to his assistant Cardiologist with the diagnosis of late infective endocarditis to Streptococcus gallollyticus. Aortic valve prosthesis replacement was necessary.

Conclusions A few cases of infective endocarditis following endoscopic procedures were described, none following endoscopic balloon dilation of a colonic stricture.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

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• 3 Shen B, Kochar G, Navaneethan U. et al. Practical guidelines on endoscopic treatment for Crohn's disease strictures: a consensus statement from the Global Interventional Inflammatory Bowel Disease Group. The Lancet Gastroenterology and Hepatology 2020; 5 (04) 393-405

Publication History

Article published online:
14 April 2023