Psychosis as Initial Presentation of Small Cell Lung Cancer: A Case Report.

Paraneoplastic neurological syndromes (PNS) are a group of symptoms and physical findings that can reflect various neurological conditions, which may uncommonly include acute psychosis. In this report, we present the case of a 62-year-old African American male with a medical history significant for sarcoidosis and adrenal insufficiency who presented with several months of altered mentation and aggressive behavior of unknown etiology. Extensive laboratory workup, including lumbar puncture and cerebrospinal fluid antibodies, did not reveal any significant findings. Imaging studies, including computed tomography of the chest, showed mediastinal adenopathy and densities suggestive of metastatic small cell carcinoma, which was later confirmed following bronchoscopy and lymph node biopsy. A PNS was suspected as the explanation for the patient's psychiatric symptoms. Treatment with steroids and intravenous immunoglobulins was started, but there was no improvement. Surgery and systemic therapy were not recommended, and the family elected to pursue a palliative care option for the remainder of the patient's treatment. Our goal in this report is to provide basic information on PNS and highlight the need for a multidisciplinary approach to the diagnosis and treatment of these rare, albeit interesting, presentations.

Validation of the Khorana score in acute myeloid leukemia patients: a single-institution experience.

BACKGROUND: Although patients with acute myeloid leukemia (AML) were shown to have an increased risk of thrombosis, no thrombosis risk assessment scoring system has been developed for AML patients. The Khorana Risk Score (KRS), which has been widely used for thrombosis risk assessment in the clinical setting, was developed on the basis of solid tumor data and has not been validated among AML patients. This study aims to validate the use of the KRS as a thrombosis risk-scoring system among patients with AML. METHODS: Using data from H. Lee Moffitt Cancer Center and Research Institution's Total Cancer Care Research Study, we retrospectively identified patients who were histologically confirmed with AML from 2000 to 2018. Clinical and laboratory variables at the time of AML diagnosis were characterized and analyzed. The thrombotic event rate was estimated with the Kaplan-Meier method and compared using the log-rank test. RESULTS: A total of 867 AML patients were included in the analysis. The median age at AML diagnosis was 75 years (range, 51-96), and the majority were male (65%, n = 565). A total of 22% (n = 191), 51% (n = 445), 24% (n = 207), and 3% (n = 24) of patients had a KRS of 0, 1, 2, and 3, respectively. A total of 42 thrombotic events (3% [n = 6/191] with a KRS of 1; 5% [n = 23/445] with a KRS of 2; 6.3% [n = 13/207] with a KRS of 3) were observed, with a median follow-up of 3 months (range, 0.1-307). There was no statistical difference in the risk of thrombosis between these groups (P = .1949). CONCLUSIONS: Although there was an increased risk of thrombosis associated with a higher KRS among AML patients with a KRS of 1 to 3, the difference was not statistically significant. Furthermore, only a few patients were found to have a KRS > 3, and this was largely due to pancytopenia, which is commonly associated with AML. These results indicate the need for a better thrombotic risk-scoring system for AML patients.