SHM Converge Scientific Abstract ePoster Gallery-Metastatic Pancreatic Adenocarcinoma Presenting as Hepatosplenic Abscesses: A Case Report

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This case report describes a 78-year-old man with hypertension, prior stroke, and end-stage renal disease on dialysis who presented with one day of diffuse abdominal pain and altered mental status. Initial evaluation showed leukocytosis and transaminitis. Abdominal and pelvic CT revealed multiple hypoattenuating hepatic lesions with hepatosplenomegaly, raising concern for liver abscesses. Blood cultures grew Clostridium inoculum, and percutaneous drainage of the liver lesions yielded pansensitive Escherichia coli.<br /><br />Despite treatment, repeat imaging showed a large hypodense splenic lesion suspicious for abscess. Tumor markers CA 19-9 and CA 125 were markedly elevated, and pancreatic-protocol CT identified a mass in the tail of the pancreas. Exploratory laparotomy with peritoneal lavage, splenectomy, and liver biopsy was performed. Pathology and immunostaining (CK7, CK20, CDX2) confirmed pancreaticobiliary adenocarcinoma metastatic to the liver and spleen. Peritoneal fluid culture later grew vancomycin-resistant Enterococcus faecium, and the patient was treated with daptomycin and ceftriaxone. Although he improved clinically, he was not a candidate for further invasive therapy or chemotherapy.<br /><br />The discussion emphasizes that pancreatic adenocarcinoma can present atypically, including as pyogenic liver or splenic abscesses. Potential mechanisms include tumor-related mucosal breach, bacterial translocation, and inoculation of metastatic sites. Dialysis may also increase risk of hepatosplenic abscess. Because pancreatic cancer is often diagnosed late and is a major cause of cancer-related death, clinicians should consider underlying gastrointestinal malignancy in older patients with unexplained liver or spleen abscesses, especially when tumor markers are elevated.<br /><br />Overall, this case highlights a rare but important presentation of metastatic pancreatic tail adenocarcinoma masquerading as multiple hepatosplenic abscesses.

Asset Subtitle

Sneha R. Adidam

Meta Tag

Author List Fatou Tine, Gregory Riley, Rachel Gordezky, Sneha R. Adidam, Wouhabe Bancheno

Category Clinical Vignettes

Concept Pancreatic Adenocarcinoma

Concept Hepatosplenic Abscess

Concept Gastrointestinal Malignancy

Concept Metastatic Cancer

Distinguished Non-Finalist

Presenter Organization Howard University Hospital

Presenting Author Sneha R. Adidam

Track Adult

Keywords

pancreatic adenocarcinoma

liver abscess

splenic abscess

metastatic disease

hepatosplenic lesions

Clostridium inoculum

Escherichia coli

tumor markers

pancreatic tail mass

dialysis

Pancreatic Adenocarcinoma

Hepatosplenic Abscess

Gastrointestinal Malignancy

Metastatic Cancer