A 76-year-old woman presented to our hospital with abdominal pain, diarrhoea and new-onset hyperpigmented spots on her tongue. Her medical history includes metastatic colon cancer, acute myeloid leukemia (AML) in remission after bone marrow transplant, hypertension, chronic kidney disease (CKD), osteoarthritis and prior internal jugular deep venous thrombosis (DVT). She had just received second cycle of 5-fluorouracil, bevacizumab and leucovorin 3 days prior to admission. Examination revealed hyperactive bowel sounds, diffuse abdominal tenderness and multiple hyperpigmented papules on her tongue (figure 1). Upright chest film did not show any gastrointestinal perforation. Abdominal CT scan was consistent with pancolitis. PCR for Clostridium difficile toxin was positive. She was started on a 14-day course of vancomycin and metronidazole and was discharged a few days later after her diarrhoea and abdominal pain improved. On follow-up 4 weeks later, the hyperpigmented papules on her tongue were noted to have improved...
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