More Than Meets The Eye

Lack of control of lower limbs reveals a set of much
more deeper problems

THE CASE

A 25-year old man was brought to the Emergency Department of BLK Super Speciality Hospital with complaints of sudden loss of power in both his lower limbs. The MRI spine revealed multiple vertebral lesions with spinal cord compression. He was taken up immediately for decompression surgery. Medical oncology opinion was sought for testicular swelling and bone metastasis. The patient needed further assessment and treatment for advanced stage Testicular Malignancy, Septicemia, Tumour Lysis Syndrome, Renal Dysfunction and Paraplegia.

All his tumour markers (AFP, beta HCG, LDH) were elevated. PETCT non-contrast revealed right Testicular Tumour with metastasis to liver and multiple bones. The family was counselled for the treatment and prognosis.

THE PROCEDURE

The patient was started under high risk consent on low dose chemotherapy with all supportive care measures for his conditions. Gradually he started showing improvement. Renal function showed improvement and complete recovery over 2 weeks. Once his general condition started improving, he was administered complete two courses of chemotherapy. In view of deep vein thrombosis, IVC fi lter was inserted by the Cardiologist.

Re-evaluation after two cycles of chemotherapy revealed complete remission of his disease. The patient was given two more cycles of chemotherapy and he continued to be in complete remission. He started showing improvement in controlling his lower limbs after 2 cycles of chemotherapy.

He underwent right orchiectomy after the complete treatment. The histopathology of specimen showed pathological complete remission.

THE RESULT

The patient showed tremendous improvement after 4 cycles of chemotherapy and he could come to the follow-up OPD walking on his own with support. He is under regular follow-up now. It has been more than 18 months and he is currently disease free.

Dr. Chandragouda

Dodagoudar
Consultant
Medical Oncology
BLK Cancer Centre
BLK Super Speciality
Hospital, New Delhi