A 75-year-old woman with a history of hypertension, arthrosis and hysterectomy presented to the hospital with a clinical picture characterized by a constitutional syndrome, asthenia, anorexia, weight loss, generalized mandibular joint pain and discomfort.
The clinical examination was normal and a normocytic normochromic anemia was detected in the analysis performed, with a hemoglobin of 8.5 mg/dl, a hematocrit of 28.6%, and a erythrocyte sedimentation rate of 112 mm/hSG
During admission to the Internal Medicine Department, he presented headache episodes and mandibular claudication for which a 1cm temporal artery biopsy was performed.
Pathology showed the presence of multinucleated giant histiocytic cells in the arterial wall, which led to the diagnosis of Temporal Arteritis.
Treatment with Prednisone 40 mg daily was initiated, which triggered secondary hyperglycemia, secondary to insulin therapy, and aggravated by complete arrhythmia due to atrial fibrillation that required the initiation of anticoagulation with coumarins.
The patient was discharged after 26 days and continued treatment with Prednisone 50 mg/day.
After 30 days, the patient returned to the emergency department with a clinical picture of frank hematuria requiring hospital admission, which resolved after discontinuation of anticoagulation.
During his stay in the Urology Department, severe anemia and progressive elevation of ESR were observed.
An abdominal ultrasound was requested, which found a heterogeneous mass of 5.7 x 5.8 cm in the upper pole of the left kidney that tomography (CT) torach-abdominal CCR-pelvic metastases identified as lymphadenopathy.
Bone screening also ruled out the presence of bone metastases.
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A left radical nephrectomy was performed, whose anatomopathological diagnosis revealed a renal carcinoma of granular and fusiform cells, affecting 40% of the ipsilateral hiliar piece, perirenal fat and pelvis, and adenopathyT0.
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Two months after surgery the patient needs a new admission due to worsening of the general condition and generalized bone pain diagnosed in CT of dorsal spinal metastases, with a torpid evolution of the disease that caused the illness.
