title: Just another abdominal pain? Psoas abscess-like metastasis in large cell lung cancer with adrenal insufficiency.
abstract: The authors report the case of a 69-year-old man with chronic obstructive pulmonary disease and previous pulmonary tuberculosis, who presented to the emergency department with abdominal and low back pain, anorexia and weight loss, rapidly evolving into shock. An initial CT scan revealed pulmonary condensation with associated cavitation and an iliopsoas mass suggestive of a psoas abscess. He was admitted in an intensive care unit unit; after a careful examination and laboratory assessment, the aetiology was yet undisclosed. MRI showed multiple retroperitoneal lymphadenopathies, bulky nodular adrenal lesions and bilateral iliac lytic lesions. Hypocortisolism was detected and treated with steroids. A CT-guided biopsy to the psoas mass and lytic lesions identified infiltration of non-small lung carcinoma. The patient died within days. Psoas metastases and adrenal insufficiency as initial manifestations of malignancy are rare and can be misdiagnosed, particularly in the absence of a known primary tumour.
authors.affiliation: Serviço de Medicina Interna 2, Hospital Curry Cabral, Lisbon, Portugal.
authors.forename: Vera
authors.initials: V
authors.lastname: Bernardino
authors.affiliation: Department of Medicina, Centro Hospitalar Oeste Norte, Caldas da Rainha, Portugal.
authors.forename: Luis Silva
authors.initials: LS
authors.lastname: Val-Flores
authors.affiliation: Serviço de Radiologia, Hospital de São José, Lisbon, Portugal.
authors.forename: João Lopes
authors.initials: JL
authors.lastname: Dias
authors.affiliation: Unidade de Urgência Médica, Hospital de São José, Lisbon, Portugal.
authors.forename: Luís
authors.initials: L
authors.lastname: Bento
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000556:secondary; D000309:Adrenal Insufficiency / Q000175:diagnosis / Q000209:etiology*; D000368:Aged; D000855:Anorexia / Q000209:etiology; D001706:Biopsy / Q000379:methods; D018287:Carcinoma, Large Cell / Q000175:diagnosis* / Q000556:secondary; D003937:Diagnosis, Differential; D017707:Erythrocyte Transfusion; D017809:Fatal Outcome; D006801:Humans; D017116:Low Back Pain / Q000209:etiology; D008175:Lung Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D009382:Neoplasms, Unknown Primary / Q000175:diagnosis*; D016659:Psoas Abscess / Q000175:diagnosis*; D016658:Psoas Muscles / Q000473:pathology*; D017582:Renal Replacement Therapy; D012121:Respiration, Artificial; D012187:Retroperitoneal Space / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed