case_images: PMC10859400_01
case_images: (A) Dark skin pigmentation.; (B) Progressive dark pigmentation of the skin over time.
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case_images: PMC10859400_01_fonc-14-1332362-g001.jpg
case_images: f1
case_images: The darkening of the skin, primarily affecting the face and torso ( Figure 1A ), began to manifest rapidly ( Figure 1B ). following the cardiac procedure.
case_images: Dark urine (melanuria).
case_images: fonc-14-1332362-g002.jpg
case_images: PMC10859400_01_fonc-14-1332362-g002.jpg
case_images: f2
case_images: Initially, this skin discoloration and melanuria (darkened urine) were unaccompanied by other symptoms, and imaging studies failed to reveal signs of metastasis ( Figure 2 ).
case_images: (A) Colonoscopy findings include colonic mucosa edema, mild inflammation, and small polyps. (B) Endoscopy of the upper gastrointestinal tract.
case_images: fonc-14-1332362-g003.jpg
case_images: PMC10859400_01_fonc-14-1332362-g003.jpg
case_images: f3
case_images: CT scan displayed enlarged subcarinal lymph nodes, each measuring up to 15 mm, without signs of clustering or evident pathological structure. Colonoscopy did not detect significant abnormalities, except for edema of the colonic mucosa, mild inflammation with minor contact bleeding, and a few small polyps that were removed during the examination ( Figure 3A ). Endoscopy of the upper gastrointestinal tract revealed dark discoloration of the duodenal bulb, accompanied by pigment spots up to 3 mm in size, with no apparent pathological findings ( Figure 3B ).
case_images: (A) Ascites (side photo).; (B) Ascites (front photo).; (C) Rapidly progressing cellulitis (erysipelas).; (D) Pedal edema.; (E) Rapidly progressing cellulitis (erysipelas).
case_images: fonc-14-1332362-g004.jpg
case_images: PMC10859400_01_fonc-14-1332362-g004.jpg
case_images: f4
case_images: On August 1, 2012, the patient presented with localized erythema, swelling, and increased warmth in the lower left extremity, indicative of rapidly progressing cellulitis (erysipelas) ( Figures 4A-E ).