Gastroenterology clinical image challenge: A 75-year-old man with a history of claudicatio intermittens and gastric ulcer presented to the emergency department with new-onset pancytopenia. White blood count differential showed 20 percent blasts. The day after admittance he developed a fever. Blood cultures were drawn and broad-spectrum antibiotics were initiated. The blood cultures grew Streptococcus bovis. The patient reported no gastrointestinal symptoms. Because of the association of S bovis bacteremia and colorectal malignancy, a colonoscopy was performed. During colonoscopy, we identified several ulcerative lesions with malignant appearance in coecum, ascending and transverse colon. Biopsies were taken.
What is the diagnosis and how should it be managed?
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