Abstract
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 Toxoplasma encephalitis, an infection whose clinical presentation had been interpreted by healthcare providers for months to be a result of metastatic cancer.
References
Dec 3, 1992·The New England Journal of Medicine·S B Porter, M A Sande
Apr 8, 1999·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·F BelangerL Meyer
Dec 13, 2005·Lupus·N DasguptaD M Fine
Mar 9, 2006·Neuropathology : Official Journal of the Japanese Society of Neuropathology·Vishal S ChandanHoward T Chang
May 15, 2009·PloS One·Andrew ZolopaLauren Komarow
Jan 12, 2010·Cases Journal·Tadashi Terada
Oct 12, 2010·Journal of Postgraduate Medicine·R K Garg, M K Sinha
Dec 29, 2011·Brain Tumor Pathology·Satoshi UtsukiNobuyuki Kawano
Nov 2, 2012·The Neurologist·Derek R Johnson, Timothy J Kaufmann
Jul 9, 2013·Oncology Letters·Shi-Qiang ZhangFang-Jian Zhou
Jul 1, 2014·The Neuroradiology Journal·Pasquale F Finelli, Ethan B Foxman
Oct 2, 2017·Acta Tropica·Ibrahim AlyElsayed M Bayoumy
Oct 29, 2017·British Journal of Neurosurgery·Atul VatsParesh Doshi
Jan 18, 2018·The New England Journal of Medicine·Robert A KyleS Vincent Rajkumar
Apr 2, 2018·Handbook of Clinical Neurology·Christina M Marra
Sep 14, 2018·Clinical Microbiology Reviews·Ildiko Rita DunayJose G Montoya
Feb 7, 2019·The New England Journal of Medicine·Eli Ben-ChetritAlon Bnaya