RESUMEN
Diagnosing small bowel cancer has been challenging due to its unusual presentation and inaccessibility on endoscopy. A 41-year-old male with a history of irritable bowel syndrome underwent esophagogastroduodenoscopy (EGD) for worsening fatigue and lightheadedness despite iron supplements therapy for low hemoglobin. Initial upper endoscopy showed esophagitis and non-bleeding duodenal bulb ulcer with exudate. Endoscopic ultrasound (EUS) with fine-needle aspiration was done due to persistent concern of malignancy and demonstrated moderately differentiated adenocarcinoma in the second portion of the duodenum. Endoscopic ultrasound with fine-needle aspiration may be a superior approach to diagnosing duodenal carcinoma than EGD alone. Small bowel cancer can be a part of the tumor spectrum of Lynch syndrome. Duodenal adenocarcinomas present at a late stage and portend a poor prognosis. We present a case of duodenal adenocarcinoma in an otherwise healthy individual emphasizing the importance of malignancy in the differential and genetic counseling in individuals with the family risk factor.
RESUMEN
A 56-year-old male with a history of type 2 diabetes mellitus and hypertension presented with complaints of intractable burning paresthesia of bilateral extremities, hyperesthesia, and unintentional weight loss. Other symptoms included anorexia, orthostatic hypotension, bowel and bladder dysfunction, and painful burning sensation on the soles of the feet. Emotional lability and a melancholy mood were noted. After laboratory tests including CSF analysis, biopsies, and three months of treatment that did not bring relief, the patient was diagnosed with diabetic neuropathic cachexia (DNC). While his diabetes remained well-controlled, the patient was unable to improve his nutritional status and his condition progressively worsened, and he later died from cardiac arrest. DNC is an important differential diagnosis to consider in patients with neuropathy and weight loss. Early detection of DNC in conjunction with weight loss investigation may reduce pain and speed recovery with a good prognosis.
