Although it may be associated with any kind of neoplasm, TS is most often related to pancreatic, lung, prostate, gastric, colorectal, ovarian and breast cancer.9 A 58-year-old man, electronics technician, was admitted in our Internal Medicine ward with deep venous thrombosis of the right lower limb. He presented http://www.selleckchem.com/products/cx-5461.html to the Emergency Department with a 3-day course of right calf pain worsened by walking, followed by swelling and increased temperature in the same limb. Throughout the whole period he felt increasing fatigue and had an episode of fainting. Just four days before the current symptoms started he had arrived from a vacation in Ecuador, during which his right upper limb had become

swollen, red and hot. He was diagnosed with right arm cellulitis and was started on antibiotic and anti-inflammatory therapy, improving subsequently. He denied fever, find more sweating, weight loss or coughing, as well as any digestive, urinary or other musculoskeletal symptoms. Past medical history was positive for some

childhood infectious diseases (measles, mumps, chicken pox), grade I arterial hypertension (known for 21 years and without medication), smoking habits (20 pack-year units), mild alcohol intake (20 g daily), chronic lumbar disc disease, left varicocele surgery (at the age of 21) and benign prostatic hypertrophy. His father deceased, with a history of chronic renal failure. There were no discernible accounts of cancer in close relatives. His physical examination revealed great overall condition and stable vital signs (BP 113/70 mmHg, HR 70 bpm, RR 20 bpm, apyrexia); no skin lesions, lymphadenopathy or thyromegaly; normal cardiac and respiratory sounds; soft, nontender, nondistended abdomen with normal bowel sounds, no masses on abdominal examination, and no hepatosplenomegaly; no evidence of infection in his right upper limb; slight swelling and increased temperature in his right leg, with positive Homans’ sign; normal neurologic exam and fundus observation within normal limits. Dichloromethane dehalogenase Laboratory tests showed the following: haemoglobin 14.6 g/dl; WBC 10.9 × 109/l

(68.1%N–20.3%L–7.1%M–4%E); platelets 258.0 × 109/l; ESR 13 mm; CRP 3.5 mg/dl (N < 1); transferrin 195 mg/dl (N: 215–365); ferritin 344.9 ng/ml (26.0–388.0); glucose 84 mg/dl; creatinine 0.6 mg/dl; albumin 3.7 g/dl; normal serum electrophoresis; AST 42 U/l (17–59); ALT 65 U/l (21–72); GGT 168 U/l (N: 15–73); ALP 209 U/l (N: 38–126); total bilirubin 0.4 mg/dl; amylase 591 U/l (N: 30–110); lipase 6356 U/l (N: 23–300); LDH 704 U/l (N: 303–618); total cholesterol 180 mg/dl; triglycerides 122 mg/dl; total calcium 9.5 mg/dl; INR 1.1; aPTT 38.0′′; factor V 130.5%; factor VIII 152.2%; protein C 97%; protein S 92.8%; antithrombin III 107%; resistance to activated protein C 3.14 (within normal limits); Lupus anticoagulant 1.94 ratio (1.6–2.0), Silica clotting time 1.26 ratio (>1.