Metástasis vertebrales como forma de presentación de un Adenocarcinoma Gástrico / Spine metastasis as an initial presentation of Gastric Adenocarcinoma

Las metástasis óseas en el cáncer gástrico son poco frecuentes y normalmente se detectan como recurrencia de un tumor o en estadios avanzados de la enfermedad. Por ello, esta forma de presentación en un adenocarcinoma gástrico es infrecuente. Presentamos el caso de una paciente de 82 años con historia de dolor lumbar de larga evolución y ausencia de síntomas gastro-intestinales. Una tomografía lumbar identificó múltiples lesiones osteolíticas y tras estudios complementarios se encontró un adenocarcinoma gástrico como tumor primario. Se inició tratamiento paliativo con radioterapia y de soporte. (AU)

Bone metastasis in gastric cancer is uncommon and usually emerges as a recurrence of cancer and in a later stage of the disease. Therefore, spine metastasis as an initial presentation of gastric adenocarcinoma is a rare event. We present the case of an 82-year-old woman, with a history of prolonged lumbar pain and no gastrointestinal symptoms. A lumbar computed tomography scan identified multiple osteolytic lesions and upon additional investigation we found a Gastric Adenocarcinoma as the primary tumor. She initiated palliative radiotherapy and best supportive care. (AU)

Is Salmonella Infection Another Possible Trigger for Polyarteritis Nodosa?

Polyarteritis nodosa is a systemic necrotizing vasculitis that typically affects medium-sized muscular arteries, with occasional involvement of small muscular arteries. Most cases of polyarteritis nodosa are idiopathic but multiple infectious agents have been associated with this disease. We present a clinical case of a 72-year-old male with fever, diarrhoea and haemodynamic instability, diagnosed with a bacterial infection caused by Salmonella Typhi. One week after clinical resolution of the infection, the patient developed purpuric lesions with ulcers, pustules and necrotic areas accompanied by testicular pain and weight loss of 5 kg over the previous 15 days. A skin biopsy was performed and it revealed typical histologic signs of polyarteritis nodosa. The aetiologic association between bacteria of the genus Salmonella and polyarteritis nodosa has been previously described in the scientific literature but seldom meeting classification criteria and with histologic confirmation. LEARNING POINTS: Polyarteritis nodosa is a systemic necrotizing vasculitis associated with a multitude of aetiologic agents.Salmonella infection might be a possible trigger for the development of polyarteritis nodosa.A high index of suspicion and awareness is essential for a swift diagnosis and treatment of this disease.