A 62-year-old patient presented with fever and abdominal pain in the right upper quadrant. He had an 18-month history of adenocarcinoma of the colon (T3N1M1) with liver metastases, for which he underwent a right hemicolectomy and received chemotherapy with irinotecan and cetuximab; in addition he underwent chemoembolization of the liver lesion. His past medical history was significant for diverticulosis, atrial fibrillation, hypertension (amlodipine 5 mg every 12 hours per os and atenolol 25 mg once a day) and appendectomy.
On examination he was cachectic and febrile with a temperature of 380C. He had hepatomegaly and his liver was hard and irregular on palpation. A scar of his previous operation was evident. Otherwise the physical examination was normal.
Investigations showed a leukocytosis and increased erythrocyte sedimentation rate and serum C-reactive protein levels. Blood cultures and urine cultures were sterile. His chest X-ray and his electrocardiogram were normal. Computed tomography scan of the abdomen showed lesions in the liver (Figure).
Computer tomography scan showing liver lesions.
Ματθαίος Ε. Φαλάγγας, MD, MSc, DSc
Γεώργιος Πέππας
Παναγιώτης Παπαγγελόπουλος
Κωνσταντίνος Ρέλλος
