PDF(Pubmed)
Abstract：
Diagnosing neoplastic fever requires excluding identifiable causes, making it a diagnostic challenge. Fever as a primary manifestation of pancreatic adenocarcinoma is uncommon with few cases reported in the literature. Here we present an unusual case of metastatic pancreatic adenocarcinoma primarily manifesting as pyrexia of unknown origin. A 63-year-old Sri Lankan male, a non-smoker who was diagnosed with diabetes, hypertension and dyslipidaemia presented with a history of fever, anorexia and weight loss for 2 months. Despite the completion of treatment for positive serology for paratyphi, his symptoms and inflammatory markers remained elevated while the rest of the infectious screening was negative. On further evaluation, the patient was found to have a hypodense distal pancreas with ring-enhancing multiple liver lesions on imaging. Histology confirmed pancreatic adenocarcinoma with liver metastasis. Atypical liver metastases may present with evidence of ring enhancement in computed tomography imaging; thus, the biopsy is mandatory for diagnosis and decision-making. Usually, tumours of the pancreatic tail are resectable but if they are associated with liver metastatic disease, surgical resection is not recommended because it is not potentially curative. Therefore, in the context of metastatic pancreatic adenocarcinoma, palliative chemotherapy and pharmacological management of fever are required.
摘要：
诊断肿瘤性发热需要排除可识别的原因，让它成为诊断挑战。发热作为胰腺腺癌的主要表现并不常见，文献报道的病例很少。在这里，我们介绍了一个不寻常的转移性胰腺腺癌，主要表现为不明原因的发热。一位63岁的斯里兰卡男性,一个被诊断患有糖尿病的非吸烟者，有发热史的高血压和血脂异常，厌食症和体重减轻2个月。尽管副伤寒血清学阳性的治疗已经完成，他的症状和炎症标志物仍然升高，而其余的感染筛查均为阴性。在进一步评估中，患者在影像学检查中发现胰腺远端低密度伴环状增强的多发性肝脏病变.组织学证实胰腺癌伴肝转移。在计算机断层扫描成像中，非典型肝转移可能存在环增强的证据；因此，活检对于诊断和决策是强制性的.通常,胰尾肿瘤是可切除的，但如果它们与肝转移疾病相关，不建议手术切除，因为它不可能治愈。因此,在转移性胰腺腺癌的背景下，姑息性化疗和发热的药物管理是必需的。
