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.