A case of leptospirosis simulating colon cancer with liver metastases.
We report a case of a 61-year-old man who presented with fatigue, abdominal pain and hepatomegaly. Computed tomography (CT) of the abdomen showed hepatomegaly and multiple hepatic lesions highly suggestive of metastatic diseases. Due to the endoscopic finding of colon ulcer, colon cancer with liver metastases was suspected. Biochemically a slight increase of transaminases, alkaline phosphatase and gammaglutamyl transpeptidase were present; alpha-fetoprotein, carcinoembryogenic antigen and carbohydrate 19-9 antigen serum levels were normal. Laboratory and instrumental investigations, including colon and liver biopsies revealed no signs of malignancy. In the light of spontaneous improvement of symptoms and CT findings, his personal history was reevaluated revealing direct contact with pigs and their tissues. Diagnosis of leptospirosis was considered and confirmed by detection of an elevated titer of antibodies to leptospira. After two mo, biochemical data, CT and colonoscopy were totally normal.
Dipartimento di Medicina Interna, Policlinico S.Orsola-Malpighi, via Massarenti, 9, 40138 Bologna, Italy. gralex@libero.it
Alessandro
A
Granito
Giorgio
G
Ballardini
Marco
M
Fusconi
Umberto
U
Volta
Paolo
P
Muratori
Vittorio
V
Sambri
Giuseppe
G
Battista
Francesco-B
FB
Bianchi
D003110:Colonic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D003113:Colonoscopy; D003287:Contrast Media; D003937:Diagnosis, Differential; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006801:Humans; D007922:Leptospirosis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D013752:Tetracycline / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
D003287:Contrast Media; D013752:Tetracycline