A 49-year-old male who had consulted several times to the emergency department and his family doctor for a fever of more than 38o of 2 months duration accompanied by nausea, vomiting and weight loss of about 10 kilograms.
The patient was an ex-smoker, was diagnosed with cryptogenic liver disease, duodenal obstruction tachycardia in which ablation had been performed 10 years ago, angina episode with normal coronary angiography, anxious-depressive syndrome and intervention.
She had not traveled recently and did not report risky sexual practices.
The clinical examination showed a temperature of 39.7 oC, hepatomegaly was present approximately 3-4 cm from the costal margin, and the rest of the examination was normal.
Complementary tests showed 15.900/mm3 leukocytes with left shift, hemoglobin 10.5 g/dl and ESR 101 mm. Biochemical tests showed an alteration in liver parameters: AST 172 13 IU/GT 208 UDH l
CRP was also high.
A urine systematic was performed that was normal, Mantoux negative.
Serologies of Brucella, Leishmania, C. Burnetti, loes, Salmonella, hepatitis A, B and C virus and HIV negative.
Serology of cytomegalovirus, Epstein-toxoplasma virus and IgG + and IgM negative were also performed.
Blood cultures were negative during the outpatient and inpatient study.
A chest X-ray was normal and an abdominal ultrasound showed liver, bile duct, gallbladder, visible retroperitoneum and portal without significant findings and signs.
Subsequently, an abdominal CT was performed in which an extensive mamelon thickening of the transverse colon wall and of the hepatic angle of approximately 12 cm large lobe heterogeneous uptake suggestive of solid tumor liver segment IV heterogeneous uptake.
These findings were made by an opaque oema which showed a defect of "mannzanian heart" filling at the junction of the transverse colon with a hepatic angle centimeters in approximately 12 cm.
In addition, a tapering was performed in which a circumferential neoplasia was observed at 110 cm of the anus that prevented the passage of the endemic, taking biopsies.
Pathological anatomy was reported as granulation tissue and connective tissue in which dense lymphocytic infiltrates with CD20+ predominance were observed, frequently expressing nuclear staining bcl-6.
The morphological changes suggested a type B lymphoma although it was not conclusive, so a hepatic FNA was performed confirming the diagnosis of diffuse large B-cell lymphoma.
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Subsequently, the patient was treated conservatively, where chemotherapy was initiated following the CHOP scheme (possible bilirubin, doxorubicin, vincristine and prednisone) and, at the moment, there are no data on this.
