Carcinoma of Unknown Primary Presenting as Peripheral Symmet
Carcinoma of unknown primary site (CUP) are a heterogeneous group of cancers for which the anatomical site of origin remains occult even after detailed investigations. Adenocarcinoma is the most common histological diagnosis in cases of cases of CUP accounting for almost 70% of the cases, the incidence of which increases with age. PAVS is a rare paraneoplastic manifestation of high grade malignancies predominantly adenocarcinomas arising from the lung, breast, gastrointestinal tract or the ovary. It has also been associated in some cases with lymphoma. In the present case report we are describing a case of adenocarcinoma of unknown primary origin presenting as PAVS.

Case Report
A 38-year-old-male, chronic smoker, woodcutter by occupation, resident of Uttarakhand presented with history of shortness of breath for preceding one week and fever for five days. On evaluation, he was found to have a massive pericardial effusion for which pericardiocentesis was performed at an outside hospital. In the next two days, patient developed severe pain and black discoloration of the digits extending till the ankle of bilateral feet. Similar complaints developed in the left hand three days later (Figure 1). There was no history of fever or respiratory distress. There was no preceding history of insect bite, rash, artharlgia or raynaud phenomenon. He was referred to our hospital for these complaints. On examination, he had tachycardia and all peripheral pulses were palpable. Blood pressure was normal in all four limbs with no pulsus paradox. He was afebrile. Generalised lymphadenopathy involving cervical, axillary and superficial inguinal nodes was present. Bilateral feet and left hand showed features suggestive of wet and dry gangrene respectively.....