A 58 year old man complains of fever for 3 weeks associated with fatigue and lassitude. He is otherwise asymptomatic and has an unremarkable medical history. He has never undergone any surgical or dental procedures and denies recreational drug use. There is no family history of malignancy. A chest x-ray and urinalysis are found to be normal.
WBC/DC: 15,000/mm3 N: 82%, L: 13 % Hb: 10.2 g/dl MCV: 70 fl (low) MCH: 25 pg (low) Platelets: 430,000/mm3 Blood Film: Microcytic hypochromic anemia
The preliminary culture report shows Gram +ve cocci in two samples. The definitive report shows isolation of Streptococcus bovis.
The echocardiogram shows an oscillatory mass attached to the mitral valve with concomitant mitral regurgitation. There are no other structural cardiac defects. The left ventricular ejection fraction (LVEF) is 63%.
Colonoscopy shows an ulcerated fungating growth in the sigmoid colon. Multiple biopsies are sent for histology.