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.