A 70-year-old male patient, hypertensive, with chronic renal failure (CRF) due to haemodialysis for three years, was diagnosed with stage IV prostate cancer secondary to nephrotic stricture secondary to metastatic adenocarcinoma of the kidney.
He was treated with goserelin and estramustine, with persistent elevation of pro-specific antigen (PSA).
During admission due to bacteremia due to sepsis related to catheter, the patient developed jaundice and pruritus.
Laboratory tests showed a cholestatic pattern: bilirubin 29 mg/dl predominantly direct, alkaline phosphatase 1713/l, normal gamma mask-glutpeptidase (GGTamine) 21U/l, with trans fatty acid
After controlling for infection, C-reactive protein (CRP) and ferritin levels were elevated.
Tumor markers were negative except for PSA (1548), and viral serology was negative (HCV, hepatitis C virus [HCV], human immunodeficiency virus).
Antinuclear antibodies, smooth muscle and antimitochondral antibodies were negative.
Computed tomography (CT) showed no liver lesions, bile duct dilatation, abdominal lymphadenopathy in bone, lesions consistent with metastases.
The patient improved, which led to her admission, although she remained with signs of hepatic stasis at all times and was discharged.
One month later, the patient developed a subdural hematoma with secondary seizures, spontaneous conservative treatment and exitus.
