Patient presents with worsening chronic diarrhea for two years and cramping abdominal pain. Patient denies any travel, antibiotic usage, dietary modifications, or sick contacts. Previous medication regimen comprised of Lomotil and Imodium were ineffective.
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Multiphase CT shows multiple liver lesions and a cystic pancreatic tail lesion.
Initial workup was negative for viral, bacterial, parasitic, inflammatory, osmotic, and malabsorptive etiologies of diarrhoea. Patient’s laboratory workup was significant for electrolyte disturbances including hypokalemia, hyponatremia (K 2.6, Na 127) and Vasoactive Intestinal Peptide (VIP) of 1930 (normal 0-60).
The patient underwent an ultrasound guided liver biopsy of a liver lesion seen on CT. Pathology results from patient's liver biopsy showed metastatic neuroendocrine cells in the liver representing a tumour arising from the endocrine pancreas (VIPoma).
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