A 38-year-old man presented abrupt hair loss on his scalp in a patchy and circular fashion, starting treatment with topical corticosteroids.
Two months later, he associated mechanical lumbar pain and later abdominal pain located in hypogastrium, vomiting and jaundice.
The analysis highlighted AST 328 U/L, ALT 995 U/L, GGT 406 U/L, AF 469 U/L and total bilirubin 7.12 mg/dL (direct 5.8 mg/dL).
Lumbar MRI showed blastic bone lesions suggestive of metastatic disease, and abdominal CT showed thickening of the gastric fundus and multiple adenopathies in cardioperitoneal angles.
Upper gastrointestinal endoscopy showed a subepidermal lesion suggestive of neoplasia and the pathological anatomy confirmed an adenocarcinoma with signet ring cells.
Percutaneous cholangiography showed diffuse involvement of the peripheral bile duct secondary to solid lesions.
The patient had a poor outcome and died one month after diagnosis.
