Case report of Leser-Trelat sign as sequela of an atypical inflammatory process

Leser-Trelat sign is a rare paraneoplastic syndrome in which one main characteristic presented is an eruption of multiple seborrheic keratoses around different areas of the body. This syndrome has been associated with multiple gastrointestinal malignancies, especially adenocarcinoma of stomach and colon. We report a 70-year-old male who presented to the surgery clinic complaining of a persistent lower abdominal pain for the past 2 months. The pain was associated with weight loss and the gradual appearance of multiple seborrheic keratoses in his body. The patient was admitted to the hospital for further evaluation, a CT scan shows an 8.1 × 5.2 cm mass in the mid mesentery and laboratories shows anemia and positive fecal occult blood. The patient was scheduled for an exploratory laparotomy. During the surgery, a large mass was found arising from the ascending colon with invasion into the adjacent sigmoid colon. The mass was sent to pathology and shows a foreign body granuloma. In addition to the surgery, the patient undergoes an endoscopic evaluation to rule out a malignancy from the upper gastrointestinal system, no masses or lesions were found. This is the first case reported, as far as our knowledge, of a foreign body granuloma in the association of Leser-Trelat sign. Foreign body granulomas are associated with multiple cellular signaling and this could be the source of the association of the Leser-Trelat sign. Further evaluation is needed to have a better understanding of the association between the Leser-Trelat sign and the formation of a foreign body granuloma. •Leser-Trelat sign is a rare paraneoplastic syndrome that is associated with malignancies.•The presence of multiple seborrheic keratosis should raised the concern of possible underlying malignancy.•Our case report present a patient that had an abrupt development with the suspicious of colon malignancy.•Final pathology shows an inflammatory mass that contained a foreign body granuloma.