Login      Sign Up
Chat with a Doctor
#MedicalCase

Rare presentation of occult malignancy (Internal Medicine)

Dr. Dipak Sopan Patade., MBBS , DNB MEDICINE

 

Medical Case Details:

41 years old female, resident of Pune, no comorbids, healthy lifestyle, h/o sudden loss of husband 4 months before since then she was little upset and had depressed affect due to Grief..2 months before started having intermittent mild frontal headache with nausea and few episodes of non bollous vomiting intermittently withput h/o fever , weight loss, night sweets or any other symptoms. No h/o tuberculsois or contact with TB patient in past. No hallucinations or delusions were noted. Headache could not affect her active daily routine but since 15 days she prefers to take more rest and eat less with sudden emotional upset - crying .feels better after vomiting .There is no h/o ear discharge , rigors or chills, or any other symotoms s/o organic disease.consulted two physicians and psychiatrist after which she was started on antidepressants with NSAIDs.resulted in partial relief.now started speaking slowly because headache.there eas no neck stifdnrss , alreration in consciousness level.kernings sign negative.underwent CSF sampling whixh revealed glucose 30 proteins 390 and cells -80% lymohocytes with ADA 5 and culture sterile.Brucella Negative, cryptococcal antigen negative. HIV/HBV/HCV negative, AFB CULTRE AND TB PCR NEGATIVE.MRI s/o meningitis hence empirically started on Anti tubercular therapy alongwith steroids.her symptoms were persistent.Meningeal biopsy s/o was reactive inflammation.rest all labs were within nomal limits.viral etiology ruled out by PCR assay.CXR and USG were non contributory.she underwent PET CT which has shown 2-4 mm lesion in left upper lung with few reactive nodes around.underwent biopsy s/o adenocarcinoma. Her LAT was stopped and Discharged after chemotherapy.

Diagnosis: carcinomatous meningitis.
Points in favour were high protein with low glucose in csf with subclinical history of symptoms.patient might look depressed or psychotic but close observation and investigations were the clue.

 


    Discussions


    Dr. Vinod Kumar Goyal
    Ayurveda Specialist

    Hi Sir
    good day
    I saw your posted case history here, so advising you, if u like it so.
    Here we are experts in cancer as i am a research scientist and hv developed new medicines, 100% effective with no side effects. So You can advise your patient to contact me here throuigh this site.
    Dr. Goyal

    ▲ 1
    09.Sep, 12:57pm

    Dr. Sujata Mittal
    Obstetrician And Gynaecologist

    Hello Dr Dipak! Read your case. Really interesting. My suggestion would be to get ihc of biopsy sample. Lung is common metastatic site. IHC will confirm it if we are dealing with primary of unknown origin .

    ▲ 1
    10.Sep, 06:54am

    Dr. Durgesh Srivastava
    Rheumatologist

    Very good Dr Deepak. I know very few people who would have gone for such an exhaustive work up...

    ▲ 2
    10.Sep, 07:19pm

    Dr. Dipak Sopan Patade
    General Practitioner

    Thanks sir.... in Deenanath Mangeshkar Hospital they discharge patient only with proper diagnosis if patient has patience to hold himself till workup gets over!

    10.Sep, 08:21pm



Are you a doctor?

Please Login to comment or ask a question.

New to icliniq? Sign Up Now

 

Similar Medical Cases


Q. fever in 9 month old - A 9 month old baby is having fever with 102degrees, consulted doctor said to take crocin (1.5ml). And told to wait for observation. What should be th ...
Q. 40 years old male, have been suffering from pain in wrist joint - Hello doctors, One of my patient, 40 years old male, have been suffering from pain in wrist joint. MRI Lt wrist indicates - 1) Negative Ulnar Var ...
Q. the effective of dental local anesthesia - Hi doctors i would like to get answer about the possibility of linking between those patient's who uses drink camel milk and the effectiveness of adm ...
Q. Severe headache in teen girl - Hi Doctors, I have a patient who has serious headache which last for 3-7 minutes. She is 16 yr old and currently no exams so I ruled out tension heada ...
Q. Multiple lipomas - 45 yr old male. He developed lipoma over his left forearm at 25 years of age, and he got it excised. Recently, he developed multiple lipomas over the ...