Ausra Bagdonaite1, Valentinas Mačiulis1, 2, Jūratė Lengvenienė1, Aldona Šiurkutė1, 2, Bernadeta Viesulaite3
1Republican Vilnius Psychiatric Hospital, Vilnius, Lithuania
2Vilnius University Medical Faculty Psychiatric Clinic, Vilnius, Lithuania
3Klaipeda Seamen’s Hospital, Klaipeda, Lithuania
Purpose: We present a clinical case which illustrates diagnostic difficulties and a tragic outcome, in which a severe mental disorder had developed for a 70 year old man. This man suffered from vermiform appendix adenocarcinoma.
Method: Clinical case.
Clinic: Paranoia symptoms persisted for 10 years; the patient was constantly afraid of getting cancer. Years before hospitalization paranoid – hallucinatory symptoms were observed. Moreover, episodic state of delirium frequently recurred. He was afraid of theives, which he believed would take away bank cards and codes. The patient suspected that his neighbor was entering his home while he was away. He acquired an alarm system, and noticed that his floor and other items were oily. He saw worms with shiny eyes, insects, and flying bats in his room, and heard them shrieking. The patient saw people without heads sitting, and that is why he slept with a lit lamp. He had an impression that things painted his hands in different colours. Orange painted hand, cakes – yellow, bed – blue. He explained that „there is such a new technology”. In dynamics, the delirium became more frequent, carfologic symptoms emerged. He was treated by tiapride 400 mg/d., haloperidol 1.5 mg/d.
Results: The delirium gradually disappeared after 50 days leaving asthenic depressive symptoms. Later on, the mood improved, and he was discharged from hospital, MMSE – 24 points. Cancer was not found. After 2 months delirium reoccurred, and after 3 months in total, ileus clinic appeared. After emergency surgical intervention, the patient died. After dissection, infiltrating adenocarcinoma of vermiform appendix and surrounding tissues and organs was found.
Conclusions: It is very difficult to say, that follow retrospective assessment has suggested that the severe mental disorders were immune mediated without neurological symptoms and somatic complaints. However, PNS can occur without an onconeuronal antibodies, and the antibodies can occur without neurological signs. Therefore severe organic mental disorders is sometimes the first and only symptoms of cancer.