Abstract
Abdominal pain is a very common presenting symptom in the emergency department (ED). To reach an accurate diagnosis one must consider the possibility of multiple conditions that might cause the presenting symptom. We reported a female patient who came to our ED due to aggravated right lower quadrant abdominal pain for several hours. Multiple diagnosis of right T11 herpes zoster, right urolithiasis with hydronephrosis, appendiceal collision tumors of adenocarcinoma arising from adenoma and neuroendocrine tumor as well as leiomyoma in the surrounding adipose tissue were made. Histological examination and immunohistochemistrysupport these three lesions as separate entities. This case is unique because her multiple combined illness present as abdominal pain. Each one could be the cause of chief complaint, across dermatologic, urologic and neoplastic disorders.