Rosso Claudia, Giscombe Lisa, Tannous Toufic, Keating Matthew
University of California, Irvine School of Medicine, Irvine, CA, USA.
Mercy Hospital Medical Partners, Miami, FL, USA.
SAGE Open Med Case Rep. 2021 May 24;9:2050313X211019784. doi: 10.1177/2050313X211019784. eCollection 2021.
In an era of fragmented medical care, concurrent clinical features that ultimately lead to a unified diagnosis may not be prioritized appropriately. We present a case of a 64-year-old woman referred to hematology clinic for anemia, with recent memory loss and gait disturbance. Two months later, she developed pneumonia; imaging workup showed a left renal mass. Neurologic function continued to decline precluding definitive nephrectomy. She then presented with new-onset seizure and initial neuro-imaging was reported as unremarkable. One month later, outpatient neurologic workup demonstrated new left-sided weakness which prompted hospitalization and repeat neuro-imaging, which showed a 1.7-cm right frontal lobe mass lesion with surrounding vasogenic edema. The patient ultimately underwent craniotomy with resection of the mass lesion; pathology did not show metastatic renal cell cancer, the provisional clinical diagnosis. Rather, immunostaining revealed a parasite and ultimately led to a diagnosis of encephalitis, an infection whose clinical presentation had been interpreted by healthcare providers for months to be a result of metastatic cancer.
在医疗护理碎片化的时代，那些最终能导向统一诊断的并发临床特征可能未得到恰当的重视。我们报告一例64岁女性病例，该患者因贫血被转诊至血液科门诊，近期出现记忆力减退和步态障碍。两个月后，她患上了肺炎；影像学检查显示左肾有肿物。神经功能持续恶化，无法进行确定性肾切除术。随后她出现新发癫痫，最初的神经影像学检查结果显示无异常。一个月后，门诊神经科检查发现新出现的左侧肢体无力，这促使患者住院并再次进行神经影像学检查，结果显示右侧额叶有一个1.7厘米的肿物病变，周围伴有血管源性水肿。患者最终接受了开颅手术切除肿物病变；病理检查未显示转移性肾细胞癌，这是初步的临床诊断结果。相反，免疫染色发现了一种寄生虫，最终确诊为脑炎，而医护人员数月来一直将其临床表现解释为转移性癌症所致。
