# No Stone Left Unturned: A Rare Case of Viridans Strep Bacteremia Secondary to Choledocholithiasis

## TL;DR

This paper presents a rare case where a strep infection came from gallstones, not the usual mouth source.

## Contribution

Highlights a novel source of viridans group streptococci bacteremia linked to choledocholithiasis.

## Key findings

- The source of VGS bacteremia was choledocholithiasis, not the oropharynx.
- The case challenges common assumptions about infection sources in VGS bacteremia.

## Abstract

When assessing a patient with bacteremia to develop an appropriate treatment plan, it is important to identify the most likely source in order to achieve source control as well as provide adequate antibiotic coverage per culture results. Through confirmation bias and the availability heuristic, it is easy to consider only the most commonly known or first options that come to mind when thinking of the source of a particular type of bacteria, potentially missing the actual source of the infection. The purpose of this report is to highlight an interesting case of undifferentiated viridans group streptococci (VGS) bacteremia where the source was not the oropharynx as is commonly thought, but rather translocation secondary to choledocholithiasis.