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.



    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

    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. Acute Anaphylactic Reaction. - BACKGROUND: Acute anaphylactic reaction is a life threatening medical emergency. Without prompt treatment, patient may die with hypotension and angioe ...
Q. Ectopic Pregnancy - Details: A 32 years old lady came to ER with severe abdominal pain and mild per vaginal bleeding since few hours. Her last menstruation period was 2 a ...
Q. Acute Anteroseptal MI - BACKGROUND - A young patient with sudden severe chest pain, needs immediate evaluation. The patient was obese and a smoker, so there was a chance of ...
Q. Acute gastroenteritis (AGE) - BACKGROUND - Why do you think this case is important? Why did you write it up? The incidence of gastroenteritis is higher in the summertime, so patien ...
Q. Sleep disturbance. - 52 years old banker. From last few months, he is not getting sound sleep. It looks as if he is awake and dreaming of different things mostly related t ...