Atypical Presentation of Pancreatic Adenocarcinoma as a Fever of Unknown Origin Mimicking Multiple Liver Abscesses: A Case Report

Pancreatic adenocarcinoma typically presents late, most often with nonspecific symptoms such as weight loss, jaundice, and abdominal pain. Presentation with prolonged fever and weakness mimicking an infectious etiology is exceedingly rare. We report a case of a 54-year-old man with no known comorbidities who presented with persistent fever, cough, and weakness of 20 days' duration. Initial investigations suggested hepatic abscesses on ultrasonography. However, further evaluation with a contrast-enhanced computed tomography scan revealed a pancreatic uncinate process mass with multiple hepatic and skeletal metastases, suggestive of advanced pancreatic malignancy. Positron-emission tomography computed tomography confirmed the presence of a pancreatic mass with widespread metastatic lesions. Increased serum cancer antigen (CA) 19-9 and CA-125 levels also supported the diagnosis of metastatic pancreatic adenocarcinoma. This case highlights the diagnostic challenge of pancreatic carcinoma presenting atypically as fever with incidentally detected liver abscess-like lesions.