Right lower quadrant mass in a geriatric patient

An 88-year old man presented at the geriatric outpatient clinic with fatigue and weakness since three weeks. One month before presentation, he was admitted with erysipelas of the left lower leg. After discharge, he progressively developed loss of appetite and fatigue. The day before presentation, he noticed a painless swollen lump in his right lower quadrant (Figure 1A). His medical history consisted of a transient ischemic attack, osteopenia, polymyalgia rheumatica treated with steroids, appendicular abscess treated with antibiotics and percutaneous drainage six years before, gallstones, chronic kidney disease, iron deficiency anemia and diverticulosis. Laboratory findings showed an elevated CRP (191.0mg/dL [≤ 5.0mg/dL]) and mildly elevated liver function tests. A computed tomography scan was performed and showed a large abdominal mass