Clinical Presentation
A case of Streptococcus gallolyticus subsp gallolyticus bacteraemia presented with fever and joint pain, leading to the diagnosis of an underlying rectal adenocarcinoma [PMID:26135668].
Diagnosis
The case underscores the importance of performing a colonoscopy in patients with S. gallolyticus subsp gallolyticus bacteraemia to identify potential colonic malignancies early [PMID:26135668].
Differential Diagnosis
This case highlights the necessity of considering infective endocarditis, particularly related to underlying malignancies like rectal adenocarcinoma, in patients presenting with fever of unknown origin and bacteraemia [PMID:26135668].
Management
TCGA data indicated that rectum adenocarcinoma patients with low UBA3 mRNA had poorer prognoses, and 27.16% of tumors expressed low UBA3 mRNA, suggesting that UBA3 levels could serve as a biomarker for NAEi sensitivity [PMID:42055937].
In a retrospective cohort study [PMID:41568735], conversion rates to open surgery were comparable across nonobese (1.0%), obese I (1.3%), and obese II (0%) groups, indicating the feasibility of this minimally invasive approach in obese patients.
The research [PMID:41568735] noted longer operative times (218 and 265 vs 194 minutes) and greater blood loss (44 and 90 vs 39 mL) in obese I and II groups compared to nonobese patients, suggesting potential challenges in surgical execution.
Complications
The study [PMID:41568735] reported anastomotic leakage rates of 4.5%, 6.3%, and 15.4% for nonobese, obese I, and obese II groups, respectively, highlighting increased complication risk in the most obese subgroup.
Prognosis & Follow-up
The study found that rectum adenocarcinoma patients with low UBA3 mRNA expression had poorer prognoses, highlighting the potential clinical significance of UBA3 levels in patient stratification [PMID:42055937].
Key Recommendations
Given that MLN4924 phase 3 trials may have failed due to a lack of patient stratification, future evaluations of NAE inhibitors should incorporate UBA3 expression as a biomarker to identify responsive patients [PMID:42055937]. (Evidence: Expert opinion)
References
1 Cruz CS, Machado C, Almeida A, Moura RB. Streptococcus gallolyticus: a single bacteria, two different conditions. BMJ case reports 2015. link 2 Miao YL, Zhou LN, Song SS, Bao XB, Huan XJ, Ding J et al.. UBA3 reduction sensitizes cancer cells to NAE inhibitors. Life science alliance 2026. link 3 Sando M, Tsukada Y, Ikeda K, Hasegawa H, Nishizawa Y, Ito M. Utility of Transanal Total Mesorectal Excision in Patients With Obesity and Mid-to-Low Rectal Cancer: A Single-Center, Retrospective Cohort Study. Diseases of the colon and rectum 2026. link