Back pain as an initial feature of advanced gastric cancer mimicking multiple myeloma: A case report and literature review.

BACKGROUND: Back pain is a rare initial presentation of gastric cancer. Isolated back pain with red flags in middle-aged patients might indicate multiple myeloma. However, it is rarely present in advanced gastric adenocarcinoma; hence, data are limited to case reports only. For a timely diagnosis of the underlying malignancy, endoscopy should be considered if the initial workup for this backache is unrevealing. CASE PRESENTATION: We present a 34-year-old previously healthy gentleman with severe unremitting backache. He was ultimately diagnosed with gastric adenocarcinoma stage IV and received palliative treatment. The manuscript also reviewed relevant literature. CONCLUSION: In rare cases, gastric malignancy can initially present as back pain with lytic bone lesions, mimicking multiple myeloma. Endoscopy early in the course of investigations may help reduce associated morbidities. Further, more extensive studies are required to understand better the clinical characteristics, demographics, and management of such patients.

Non-diabetic ketoacidosis secondary to primary hyperthyroidism: A case report.

INTRODUCTION: There are variable complications of hyperthyroidism, including atrial fibrillation, heart failure, osteoporosis, and thyroid storm. One infrequent complication of hyperthyroidism is non-diabetic ketoacidosis (NDKA). To the best of our knowledge, our case is the third report of NDKA related to thyrotoxicosis. PATIENT CONCERN: We describe a case of a 41-year-old African lady with no past medical history presented to our hospital with severe abdominal pain and vomiting for three weeks. This was associated with decreased appetite and weight loss. DIAGNOSIS: Laboratory findings were significant for high anion gap metabolic acidosis, positive ketones in the urine, and high serum B-hydroxybutyrate. The blood glucose readings and HbA1c were within normal limits. Also, serum lactic acid and salicylate levels were within the normal range. The diagnosis of NDKA was made. Later, the thyroid functions test (TFT) confirmed the diagnosis of primary hyperthyroidism. INTERVENTION AND OUTCOMES: The patient was managed initially with intravenous fluid and antiemetics. Then, she was started on propranolol and carbimazole. After which, her symptoms improved dramatically, and the metabolic acidosis (with serum ketones) were corrected within a few days of starting anti-thyroid medications. CONCLUSION: Despite its rarity, NDKA can be associated with severe thyrotoxicosis. Vigorous intravenous hydration and anti-thyroid medication are the mainstay treatment. TFT should be requested in a patient with unexplained NDKA.

Groove Pancreatitis Associated with Transient Liver Injury Mimicking Ampullary Neoplasm.

Groove pancreatitis is an unusual form of pancreatitis characterized by fibrous inflammation and pseudo-tumor in the area around the head of the pancreas. The underlying etiology is unknown but is strongly linked to alcohol abuse. We report a 52-year-old male smoker with hypertension, asthma, and alcohol abuse who was admitted with severe epigastric pain radiating to the back. He was found to have acute pancreatitis. A computed tomography scan of the abdomen showed a mass lesion in the peri-ampullary region. MRI of the abdomen revealed dilated common bile duct and duodenal mass and features suggestive of groove pancreatitis. During the hospital stay, bilirubin and liver enzymes started to rise and then decreased gradually to the previous normal range. The secondary workup for liver disease was unremarkable. The patient improved and was discharged. Six-month follow-up showed regression of the duodenal lesion and reduction in the common bile duct dilatation. Excluding malignancy remains the main challenge in managing groove pancreatitis, and a conservative approach is more reasonable in cases with a typical profile.