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Despite extensive diagnostic efforts, a diagnosis of adenocarcinoma of probable pancreatobiliary origin was established only at an advanced stage, leading to a fatal outcome within a week. The patient experienced rapid clinical deterioration, characterised by refractory respiratory failure, haematological dysfunction and circulatory shock, highlighting the aggressive course of pancreatic cancer and its complications. This case underscores the diagnostic challenges and the critical need for early recognition and tailored strategies in managing complex presentations of pancreatic cancer, especially with rare and severe systemic manifestations.<\/jats:p>","DOI":"10.1136\/bcr-2025-264969","type":"journal-article","created":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T04:15:24Z","timestamp":1745554524000},"page":"e264969","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Pancreatic cancer unveiled by multisystemic manifestations"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0284-6686","authenticated-orcid":false,"given":"Rita","family":"Noversa de Sousa","sequence":"first","affiliation":[{"name":"Internal Medicine, Pedro Hispano Hospital, Matosinhos Local Health Unit, Matosinhos, 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