A 72-year-old female patient, whose personal history highlights the presence of stage I COPD, hypertension treated only by dietary measures, beta-thalassemia and atopic dermatitis.
The patient has a smoking habit of 30 packs/year without other toxic habits.
The patient began to be studied in the vascular surgery service in May 2003 due to the appearance of deep, painful ulcers in both lower limbs, the greatest of them finally being diagnosed with a skin lesion after a biopsy, without improvement with the lesions.
Having said immunological finding, the patient was referred to the internal medicine service in May 2004 where the patient underwent several diagnostic tests, highlighting the normality in the tests performed, both in imaging tests and in the study.
The patient also denied any digestive symptoms.
Corticosteroid and cyclosporine A treatment was established with very good clinical response, so the patient follows this treatment until November 2004 as well as local cures of ulcerative lesions, although with persistence of these lesions.
In November 2004, the patient began with nonspecific gastrointestinal symptoms consisting of diffuse abdominal discomfort and altered intestinal rhythm, so when the patient's symptoms and anemia were observed (in principle attributed to beta-intermediate rectal exam and rectal examination).
The pathological analysis showed the presence of colloid mucosecretory adenocarcinoma.
The diagnosis referred to above is made by the patient undergoing an amputation with a non-perineal tape and a terminal illness left on January 2005.
The final pathological result was a moderately differentiated mucosecretory adenocarcinoma with extensive necrosis affecting the entire wall thickness.
Adenocarcinoma was diagnosed in five out of nine isolated lymph nodes.
Free margins.
After surgery, the patient underwent an extension study, which revealed the presence of multiple lung metastases and adenopathic involvement at the mesenteric, retroperitoneal and pelvic levels.
The patient was diagnosed with stage IV adenocarcinoma managed conservatively with chemotherapy regimen FOLFOX-6, which began in February 2005.
The response to chemotherapy was favorable, with partial response of lung metastases and disappearance of adenopathic involvement, as well as decrease of tumor markers.
As for pyoderma gangrenosum and without the treatment previously followed for it, the evolution towards complete disappearance of both manifestations was added, without any type of symptomatology.
However, during the course of treatment (finalized on the 4th cycle) the patient comes to the emergency department for a fever of 39°, nausea, vomiting and abdominal pain in right hypochondrium neutropenia and grade IV liver failure.
the suspicion of septic shock secondary to cholangitis, proceeds to his admission in the Intensive Care Unit, where the necessary antibiotic measures were established, as well as vasoactive drugs, without achieving the resolution of the process and
