Streptococcus lutetiensis prosthetic shoulder infection assisting in the diagnosis of invasive adenocarcinoma of the colon

Prosthetic joint Infection (PJI) due to Streptococcus bovis group (SBG) is an uncommon bacteria isolated from cultures of synovial fluid analysis. It is, however, is a common gut microbiota, with far greater incidences in individuals with colonic pathologies, particularly neoplasms of the colon. Specifically S. bovis biotype II/1 (S. lutetiensis) has been seldom studied regarding PJI. When it grows in a joint tap of a prosthetic joint it is oftentimes associated with underlying colorectal carcinoma. This is due to colorectal carcinoma altering the native gut microbiome in an individual and dysrupting endodermal layer of the gut, causing a hematologic seeding through the blood from the colon. Disruption of colonic mucus with cancer causes bacterial translocation and seeding throughout the body and it preferably grows on foreign material, particularly prosthetic joints. This is a case report on an anatomic total shoulder arthroplasty that had S. lutetiensis infection which was found to be associated with an underlying asymptomatic colorectal carcinoma. The pathogenic factors allow the bacteria to create a biofilm on the prosthetic joint with a resulting infection. A SBG PJI should be worked up with colonoscopy. Additionally, the surgical treatment of a PJI is dictated by the acuity of the infection with a 6-week course of IV Vancomycin to control the acute infection in addition to a 6-month course of oral Clindamycin to prevent recurrence.