Cullen's sign associated with metastatic esophageal carcinoma

Cullen's sign refers to the presence of periumbilical ecchymosis and is most often recognized as a manifestation of hemorrhagic pancreatitis. However, lesser-appreciated etiologies include ruptured ectopic pregnancy, leaking aortic aneurysm, and intraabdominal malignancy. We report the case of a patient with metastatic adenocarcinoma of the esophagus who developed Cullen's sign shortly before death. Based on this case and previously reported cases, malignancy-associated Cullen's sign portends a dismal prognosis, and may be considered a pre-terminal finding.