We report the case of a 73-year-old patient who presented with jaundice and constitutional syndrome of less than 2 months duration.
In the Emergency Department a great painful hepatomegaly was evident and the analytical tests showed leukocytosis with neutrophilia and mixed alteration of the cholestatic profile with less normal hepatic insufficiency and AST and GGT more than 10 times.
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Twenty-four hours after admission the patient developed confusional state that rapidly progressed to coma and fever greater than 39 oC.
Abdominal ultrasound and CT were performed, showing multiple space-occupying hepatic lesions, hypodense solid, distributed in both lobes occupying almost the entire organ, suggesting MTS.
No infectious focus was found, several hemocultives were sterile and the presence of brain lesions had been ruled out by CT.
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Analytically, the hepatic profile deteriorated, presenting a significant increase in transaminase levels in the range of acute hepatitis (ALT and AST > 20 times the normal value with a significant increase in LDH) and data of progressive liver failure.
Despite its rapid consequence established due to antiencephalopathy measures, vasoactive drugs, broad-spectrum antibiotics at high doses (to cover the CNS as a possible focus) and fresh frozen plasma transfusion, the patient died 5 days after admission.
For this reason a clinical autopsy was performed.
The necropsy confirmed the existence of extensive hepatic MTS.
The primary tumor was a cecal adenocarcinoma of 3 x 2 cm in diameter, stage D Dukes and IV Astler-Coller.
She presented with insanity, perivascular fat and lymphatic and venular fat.
MTS in infradiaphragmatic locoregional ganglia and pulmonary parenchyma.
In addition, lesions of associated ischemic hepatitis and cholangiolitis and extensive pancreatic and peripancreatic autolysis were observed.
