Case 282 | JoVE Visualize

Area of Science:

Internal Medicine
Gastroenterology
Oncology

Background:

A 63-year-old female with a history of breast cancer (left mastectomy) and nonhealing peptic ulcer (partial gastrectomy with Roux-en-Y reconstruction) presented with a month of concerning symptoms.
The patient reported progressive abdominal distention, fevers, chills, and flu-like symptoms, initially treated empirically with oseltamivir without resolution.
Persistent fatigue, fever, chills, abdominal bloating, and loss of appetite indicated a need for further diagnostic evaluation beyond a simple viral illness.

Purpose of the Study:

To investigate the underlying cause of persistent flu-like symptoms and abdominal distention in a patient with a complex surgical history.
To evaluate the diagnostic utility of laboratory markers and imaging in identifying the source of infection or inflammation.
To determine the appropriate management strategy for a patient presenting with severe systemic symptoms and elevated inflammatory markers.

Main Methods:

Clinical presentation and patient history were documented, including prior oncologic and gastrointestinal surgeries.
Laboratory studies were performed, revealing leukocytosis, elevated erythrocyte sedimentation rate (ESR), and elevated C-reactive protein (CRP) levels.
Abdominal and pelvic computed tomography (CT) scans were utilized for detailed anatomical and pathological assessment.

Main Results:

Laboratory findings indicated significant systemic inflammation: white blood cell count of 15.1 × 10^3/µL, ESR of 100 mm/hr, and CRP of 203.8 mg/L.
Liver function tests showed elevated liver enzymes (AST, ALT, ALP) and total bilirubin, suggesting hepatobiliary involvement.
Abdominopelvic CT imaging was performed to visualize intra-abdominal structures and identify potential sources of pathology.

Conclusions:

The patient's persistent symptoms and laboratory findings pointed towards a significant underlying inflammatory or infectious process.
Elevated inflammatory markers and liver enzyme abnormalities necessitated a comprehensive diagnostic workup, including advanced imaging.
The case underscores the importance of thorough investigation in patients with complex medical histories presenting with atypical or persistent symptoms.