Colorectal Carcinoma and Gluteal Abscesses in the Background of a Gait Disturbance Presentation

Profuse diarrhea and abdominal discomfort are well-documented symptoms of patients with known colorectal cancer. It is much less common for these patients to present with a chief complaint of gait disturbance and rhabdomyolysis. We present a case of incidentally discovered colorectal carcinoma in a patient who was initially evaluated for progressive weakness and recurrent falls.

A 51-year-old man was admitted to our department for management of rhabdomyolysis in the setting of progressive lower extremity weakness and mechanical falls. He developed abdominal discomfort and bowel changes during his admission, and after further investigation, he was found to have a rectal polyp positive for invasive adenocarcinoma, as well as multiple gluteal abscesses. Workup for metastasis, mutations, and oncogenic biomarkers was unremarkable.

This case is a demonstration of a medically complex patient presentation compounded by multifactorial processes. Future providers may take note that an initial absence of classic gastrointestinal (GI) symptoms does not necessarily rule out underlying GI cancer. Instead, the initial presentation of colorectal adenocarcinoma may manifest with paraneoplastic versus incidental progressive proximal limb weakness prior to GI symptoms such as diarrhea. Additionally, our report demonstrates a case of possible paraneoplastic gluteal abscesses, which may have further contributed to the patient's gait disturbance. However, it is unclear as to whether our patient's various symptoms were directly linked to one another, or if they were incidental co-presentations.