Case 282.

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.