Male, 60 years old, smoker of 20 cigarettes/day, COPD (type chronic bronchitis).
Interoperated disc herniations L4-L5-S1-S2, biliary lithiasis with stasis pattern.
Gastric adenocarcinoma (T3N1M0, IIIa) treated 4 years earlier by total gastrectomy + posterior resection + distal pancreatectomy + esophageal anastomosis and without chemotherapy and radiotherapy Royuuxectomy.
Epigastric pain and frequent diarrhea along with anemia secondary to malalignment.
She had been treated with phenytoin for epileptic seizures for 4 months.
On follow-up by the Ongoing Care Service there was no evidence of tumor recurrence, although the patient continued to receive chronic dexamethasone treatment.
The patient was admitted due to an increase in diarrhea along with fever of 38 oC base. The lesions in the lower limbs were described as pustular and blistery, and signs of pneumatic consolidation were confirmed by X-ray.
The fever and pneumonic condensation disappeared after treatment with levofloxacin for two weeks.
Similarly, pain, diarrhea and heart rhythm alterations disappeared after treatment with digitalis. Weakness of the lower limbs persisted, as well as lesions that extended into a necrotic, centrally erythematous, abdominal surface.
Neither the imaging techniques performed (cranial, thoracic and abdominal CT and bone scintigraphy) nor the bone marrow biopsy and biopsy showed metastatic lesions, nor tumor aspiration.
MRI of the spine showed osteomalacia; decreased 25-OH-D levels were observed.
This osteomalacia could be explained by intestinal malabsorption of vitamin D, pancreatic insufficiency or treatment with anticonvulsants, three circumstances that occurred simultaneously in this patient.
The hemocultive, urocultive and coprocultive were negative, as well as the serology of HIV and CMV.
For the diagnosis of dermatological lesions, samples were taken for pathology and microbiology.
The biopsy showed cells with foreign body inclusions suggestive of malignant disease or dermatophytosis.
The microbiological study confirmed the dermatophytosis, with the isolation of Trichobate menta (CDM) in the culture of the sample taken from the hand lesions, and Alternaria sp in the culture of the sample taken.
Treatment with itraconazole was initiated with a very good clinical response, and the patient was discharged a few days later, although the dermatology department reviewed the cases and internal medicine.
