Endocarditis: Pathology review

A 67-year-old man presents to the primary care physician with a several week history of worsening fatigue, blurry vision, and rectal bleeding. Medical history is notable for ulcerative colitis, hypertension, and hyperlipidemia. The patient’s last colonoscopy was at age 50. Temperature is 37.6°C (99.7°F), pulse is 96/min, respirations are 18/min, and blood pressure is 122/63 mmHg. BMI is 34 kg/m2. Physical examination demonstrates an obese habitus. The patient’s skin appears pale with noted conjunctival pallor. Cardiopulmonary examination demonstrates a 3/6 holosystolic murmur best at the cardiac apex which was not present at the previous office visit 3 months ago. Retinal examination demonstrates round white spots on the retina surrounded by hemorrhage. Rectal examination is positive for scant blood in the rectal vault. Laboratory values are demonstrated below: