No abstract

Parotid acinic cell carcinoma (ACC) is a rare tumor of the salivary gland with minimal data on systemic therapy options. We report a case of metastatic parotid ACC with widespread visceral metastases presenting with ectopic adrenocorticotropin hormone (ACTH) syndrome (EAS). To date, only 2 such cases have been reported, each with rapid demise of the patient due to sepsis. 1,2 Immunostaining for ACTH in the primary tumor should be considered to assist in early diagnosis and prevent morbidity and mortality associated with this complication.

SummaryOur patient had drainage of a large amoebic liver abscess. This got complicated by a severe degree of hypotension, which required aggressive fluid resuscitation and hydrocortisone support. Computerised tomography (CT) of the abdomen revealed bilateral adrenal gland haemorrhage (BAH) resulting in primary adrenal gland failure, which was the cause for hypotension. Patient was on long-term warfarin for provoked deep vein thrombosis of lower limb, which was discontinued before the procedure. Thrombophilia profile indicated the presence of lupus anticoagulant factor with prolonged activated partial thromboplastin time (aPTT). Patient was discharged on lifelong warfarin. This case emphasises the need for strong clinical suspicion for diagnosing BAH, rare but life-threatening condition, and its association with amoebic liver abscess and anti-phospholipid antibody syndrome (APLS).Learning points Recognition of BAH as a rare complication of sepsis.APLS can rarely cause BAH.