LAUSR

and normal platelets and INR. Previous LFTs were normal. CT CAP was arranged and it showed bilateral PEs, kidneys and spleen infarction and multiple liver metastasis with unknown primary. Treatment dose of LMWH was started. Anti-phospholipid antibodies, HIV, Hepatitis and vasculitis screening was negative and non-invasive liver test: autoimmune liver screen, iron studies, A1AT, serum ceruloplasmin were negative. Gastro team was involved and MRI liver was planned. MRI liver showed multiple liver metastasis with primary mass in the tail of pancreas. Cancer screening bloods showed high CA 19-9 >10000.0 with normal AFP, CEA and PSA. We took collateral history from his mom who mentioned that he went to the GP for right leg pain three months ago and he was treated for right leg sprain. He then developed left leg pain one month later and attended hospital where he was treated for left leg cellulitis. D-Dimer at that time was 6501. The clinical events explained that most likely he developed Trousseau’s syndrome three months ago and the embolic phenomena was due to Marantic endocarditis (Non-bacterial thrombotic endocarditis) secondary to pancreatic cancer. MDT advised for USS guided liver biopsy, but sadly he passed away the next day due to deteriorating clinical condition.