PMC9067158_01
CT (A, B) and PET-CT (C) appearances of metastatic jejunal melanoma. 1 = Metatstatic jejunal small bowel obstruction. 2 = Retroperitoneal lymphadenopathy. 3 = Multifocal small bowel mesenteric melamona. 4 = Metastatic left axillary lymphadenopathy.
fimmu-13-871217-g001.jpg
PMC9067158_01_fimmu-13-871217-g001.jpg
f1
A contrast-enhanced computerized tomography (CT) scan ( Figure 1 ) identified a thickened small bowel wall with mesenteric and retroperitoneal lymphadenopathy. Full skin examination and baseline staging positron emission tomography-computed tomography (PET-CT) showed no evidence of primary cutaneous melanoma ( Figure 1 ) or other measurable diseases apart from left axillary lymphadenopathy (3.6 cm), small bowel mesenteric and retroperitoneal lymphadenopathy.
PMC9067158_02
Schematic of main events. D, day; Ipi, ipilimumab; Nivo, nivolumab; ED, emergency department presentation with abdominal pain and fatigue; Hb, haemoglobin (g/dl); P, platelets (X109/l); IVMP, intravenous methylprednisolone; RCC, red cell concentrate, PLX, plasmapheresis.
fimmu-13-871217-g002.jpg
PMC9067158_02_fimmu-13-871217-g002.jpg
f2
One week later (day 8), he represented with severe abdominal pain, constipation, grade 1 anorexia, and grade 2 fatigue ( Figure 2 ).