title: Middle aged male with recurrent episodes of confusion, aggressive behavior and loss of consciousness.
abstract: We report a case of a 63 years-old-male with repeated bouts of confusion, aggressive behavior, dizziness and loss of consciousness occurring over a year. Such episodes increased in frequency and severity over time and were treated at the Emergency Room with intravenous dextrose solutions. Admitted at San Juan Bautista Medical Center due to severe hypoglycemia. Laboratory evaluation and prolong fasting ruled out an insulinoma or surreptitious administration of insulin or sulfonylurea. A CT scan of the abdomen and pelvis with oral contrast demonstrated a huge intra-abdominal mass invading the mesentery with herniated components laterally in the right lower quadrant. Patient underwent surgical resection of the abdominal mass. Histological description demonstrated a neoplastic pattern. Immunohistochemistry was compatible with an undifferentiated Synovial Sarcoma.
authors.affiliation: San Juan Bautista School of Medicine and San Juan Bautista Medical Center, Caguas, Puerto Rico. jhernan.martinez@gmail.com
authors.forename: Martínez José
authors.initials: MJ
authors.lastname: Hernán
authors.forename: Orengo Solalba
authors.initials: OS
authors.lastname: Bueno
authors.forename: Jose
authors.initials: J
authors.lastname: Rosa
authors.forename: Melvin
authors.initials: M
authors.lastname: Lopez
authors.forename: Cortes
authors.initials: C
authors.lastname: Carlos
authors.forename: Luis
authors.initials: L
authors.lastname: Ramos
authors.forename: Adalberto
authors.initials: A
authors.lastname: Mendoza
authors.forename: Begoña
authors.initials: B
authors.lastname: Tejedor
mesh_terms: D000374:Aggression; D003221:Confusion / Q000209:etiology; D006801:Humans; D008297:Male; D008643:Mesentery; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000150:complications / Q000175:diagnosis*; D012008:Recurrence; D013584:Sarcoma, Synovial / Q000150:complications / Q000175:diagnosis*; D014474:Unconsciousness / Q000209:etiology