ABSTRACT
A 29-year-old male presented with acute left-sided weakness in both the upper extremity (UE) and lower extremity (LE), an atypical symptom for testicular cancer but not uncommon for brain metastasis. Testicular cancer usually manifests as a testicular mass or discomfort. His medical history included a previously resected testicular mass, with pathology results unknown due to the patient being lost to follow-up. Upon examination, he exhibited significant neurological deficits and multiple subcutaneous nodules. Imaging revealed multiple enhancing brain lesions and widespread metastases to the lungs and other regions. Laboratory tests showed elevated alpha-fetoprotein and lactate dehydrogenase levels, supporting a diagnosis of advanced non-seminomatous germ cell tumor. He received multidisciplinary treatment, including dexamethasone, levetiracetam, and chemotherapy. The patient responded well to the treatment, showing significant improvement in neurological function and stabilization of his condition. This case underscores the diagnostic and therapeutic challenges of metastatic testicular cancer, particularly with rare presentations such as cutaneous involvement, and highlights the importance of comprehensive diagnostic evaluations and multidisciplinary care.
ABSTRACT
Lymphoma, a term encompassing tumor masses in the lymph nodes, is often classified into Hodgkin and non-Hodgkin lymphomas, each with distinct subtypes. We present the unique case of an HIV-positive patient diagnosed with Burkitt lymphoma and classical Hodgkin lymphoma simultaneously as a composite lymphoma. Over the course of five years, a variety of dose-adjusted chemotherapy regimens were used that ultimately proved highly effective. The successful management of this rare case reinforces the significance of considering unexpected combinations of neoplastic processes during diagnosis and treatment planning.
ABSTRACT
This case report delineates the intricate interplay between psychiatric and oncological pathology in a 72-year-old male diagnosed with low-grade marginal zone B-cell lymphoma and severe psychiatric disturbances, including catatonia. The presentation of severe psychiatric symptoms initially obscured the underlying lymphoma, delaying diagnosis and complicating clinical management. Notably, the lymphoma itself may have precipitated or exacerbated the psychiatric condition, underscoring the potential for oncological diseases to manifest with rapidly progressive dementia and catatonia. A multidisciplinary approach was employed, utilizing electroconvulsive therapy (ECT) for rapid resolution of catatonia, which facilitated significant mental health improvements and clearer delineation of the oncological underpinnings. Concurrently, the patient was treated with rituximab, targeting the lymphoma. This case highlights the critical need for a comprehensive evaluation in patients presenting with psychiatric symptoms, particularly in the elderly, to uncover potential medical causes and illustrates the efficacy of ECT in managing psychiatric conditions that may overshadow or complicate concurrent medical issues.
ABSTRACT
Autoimmune diseases, a term encompassing conditions where the immune system targets its own cells, consist of various pathologies, two of which are systemic lupus erythematosus (SLE) and mixed connective tissue disorder (MCTD). We present the unique case of an anti-ribonucleoprotein (RNP)-positive patient exhibiting renal pathology consistent with lupus nephritis and an additional collapsing variant of focal segmental glomerulonephropathy, who initially presented to the emergency department with signs and symptoms of pneumonia and portal vein thrombosis that were subsequently treated. Conflicting accounts of her autoimmune history led to an extensive workup during her stay, which yielded a tentative diagnosis of SLE vs. MCTD during her current hospitalization for pneumonia. The diagnostic labs revealed conflicting serological markers, with delayed anti-Smith positive results favoring lupus due to its high specificity. A subsequent renal biopsy showed complex renal involvement, suggesting SLE, despite initial positive anti-RNP antibodies known to be protective against renal pathology and classic for MCTD. Complicating matters further, the renal biopsy findings extended beyond common SLE pathology, including additional focal segmental glomerulonephritis (FSGS) involvement. Despite this uncertainty, the patient was treated as if solely having SLE, and immunosuppressives that could have been utilized for the possible MCTD component were avoided due to minimal signs of inflammation/immune response and normal kidney function. This case highlights the difficulty in accurately classifying lupus and MCTD, emphasizing the need for precise diagnosis for tailored patient care. Ongoing research is crucial to refine diagnostic criteria and improve patient outcomes.