ABSTRACT
Abstract Background Metastatic tumours sometimes present with neuropsychiatric symptoms, however psychiatric symptoms as rarely the first clinical manifestation. Cutaneous melanoma is the third most common cause of brain metastasis, with known risk factors increasing the chance of such central nervous system metastization. Objectives We present a clinical report of delirium as the first clinical manifestation of melanoma brain metastases, illustrating the relevance of an adequate and early differential diagnosis. Methods In addition to describing the clinical case, searches were undertaken in PubMed and other databases using keywords such as “brain metastasis”, “melanoma”, “agitation”, “psychiatric” and “delirium”. Results We here report the case of a 52-year-old female patient evaluated by Liaison Psychiatry after sudden onset of delirium while admitted at the Gastroenterology Department to study a hypothesis of pancreatitis. A head CT scan identified brain metastases, and after further examination, including brain biopsy, melanoma brain metastization was confirmed. Discussion Some of the diagnostic challenges of psychiatric symptoms associated with secondary brain tumours are discussed, underlining the importance of an adequate differential diagnosis when working in Psychiatry Liaison.
ABSTRACT
We present the unusual case of a 35 year-old woman with stage IV melanoma and widespread metastases, who was undergoing treatment with interferon alpha-2b and who presented with interferon-associated retinopathy. The patient, who had been taking interferon treatment for three months, complained of a sudden loss of visual acuity in the left eye. An ocular examination revealed multiple cotton wool spots along the retina and macular involvement. Interferon treatment was suspended. Although rare, retinopathy represents a potentially serious adverse effect of interferon treatment. Although normally patients are asymptomatic, complications derived of its use may arise, which can lead to significant visual impairment. We therefore suggest that before initiating treatment with this drug, patients should be informed of its potential ocular risks, and that regular eye examinations are conducted along with the treatment.
Apresentamos o caso de uma mulher de 35 anos com melanoma em estágio IV e metástases generalizadas tratados com interferon alpha-2b, que proporcionou uma retinopatia associada ao interferon. Mulher de 35 anos de idade tratados com interferon durante os últimos três meses apresentou uma perda súbita da acuidade visual no olho esquerdo. Exame ocular revelou vários pontos de algodão ao longo da retina e mácula. Tratamento com interferon foi parado. Retinopatia associada ao uso de interferon está entre os possíveis efeitos colaterais, embora rara, não deve ser subestimada. Embora geralmente assintomática, complicações decorrentes de seu uso podem levar à perda visual significativa. Consideramos, portanto, que antes de iniciar o tratamento com este medicamento, os pacientes devem ser informados sobre os riscos potenciais e os exames oftalmológicos são recomendados durante cada tratamento.