Metastatic Clear Cell Renal Cell Carcinoma with an Unknown Primary in a Living Donor Kidney Transplant Recipient

A 68-year-old male presented to the emergency department with severe epigastric pain six months post living donor renal transplant from his daughter-in-law. The patient had an uncomplicated transplant course and was in his usual state of health until the onset of fatigue and constant abdominal pain one week prior. He also reported weight loss, decreased appetite, and night sweats. Past medical history included hypertension, diabetes type II, basal cell carcinoma, and coronary artery bypass surgery. The physical exam was unremarkable except for jaundice and pallor. An abdominal CT scan, colonoscopy, and esophagogastroduodenoscopy were performed several days earlier at a different facility and did not show acute pathology. He was admitted for further workup due to the severity of the abdominal pain. Abstract