Unusual Fever Precedes Diagnosis of Mesothelioma

Mesothelioma is a general term that refers to cancer of the tissues that surrounds the lungs, abdomen, or heart. A remarkable mesothelioma case was recently discovered in a 48-year old woman living on a rural farm. Her ultimate diagnosis of malignant peritoneal mesothelioma (MPM) of the appendix manifested through rare and insidious symptoms. Mesothelioma is most frequently associated with exposure to asbestos fibers, thus common in men who worked in construction, shipyards, or mining industries. Symptoms often include rapid weight loss, abdominal pain or distension, and intestinal obstruction. Mesothelioma attorneys at Pintas & Mullins Law Firm urge those who have been exposed to asbestos and display any of these symptoms to contact your physician immediately.

At diagnosis, the woman was found to have metastatic mesothelioma of the appendix, the first of its kind. Metastatic refers to the specific location in the body where the cancer develops and spreads from. Known metastatic sites for MPM are the brain, kidney, lungs, bone, lymph nodes, thyroid, skin, soft tissue, adrenals, liver, pancreas, and now, for the first time, the appendix.

The woman was the wife of a farmer and a non-smoker. Just four months prior to hospitalization, she began experiencing chills and a persistent fever ranging from 102 – 104 degrees Fahrenheit. She also reported slight lower abdominal discomfort which was relieved by urination. Weight loss of 11 pounds and complete loss of appetite occurred in the last two months before hospitalization without nausea, vomiting, diarrhea, or abdominal pain or distension. Many broad spectrum antibiotics were given without relief of fever.

Results from chest, heart, and abdominal examinations were unremarkable, and blood chemistry was normal. A purified protein derivative test, four sets of blood cultures, serum and urine protein electrophoresis, and a chest radiograph were all negative. A bone marrow aspiration and biopsy were normal.

Finally, a laparoscopy was performed (a surgery into the abdomen to look at the abdominal or female pelvic organs). Troubling findings from this led to three additional surgeries. Microscopic examinations confirmed the diagnosis of appendix metastases of an MPM. The woman refused chemotherapy and was discharged from the hospital on Day 15 after surgery.

This is the first report of MPM presented with fever and other related symptoms. The complaint of slight discomfort in the lower abdomen, which is the critical clue to the diagnosis, was easily overlooked. Therefore, the detailed history is extremely important for identifying the key symptoms and making a correct diagnosis. Clinicians must pay more attention to the symptoms no matter how minor.

MPM is a rare tumor that develops in the peritoneum. Some patients present symptoms of ascites, tenderness, and palpable masses. Persistent high fever is exceptional. Owing to the non-specificity of these clinical symptoms, the diagnosis is difficult to make during the early stages of the disease. The poor median survival rate of the disease (60-90 months) is the consequence of lack of early detection methods and technology. Awareness of such atypical presentations of mesothelioma may help to make a correct diagnosis.

The disease affects more men than women because of the above mentioned occupational exposure to asbestos. Other co-factors have been linked to malignant mesothelioma development, such as genetic predisposition and exposure to erionite. This cancer was once rare and is now showing an increasing incidence worldwide following the vast mining of asbestos, which peaked in the 1970s. Presently, although asbestos-related activities have been curtailed in most countries, the enormous historical production and use of asbestos in the form of various building materials and commercial products have resulted in millions of people being exposed to asbestos and a proportion of them now having asbestos-related diseases.

The diagnosis of mesothelioma occurs 10-50 years after exposure. Although peritoneal mesothelioma is a progressive and fatal cancer, novel treatment approaches using peritonectomy procedures have demonstrated survival benefits. To reduce its occurrence and associated morbidity and mortality, avoiding asbestos exposure as a primary prevention approach is of utmost importance. If you developed an illness as the result of asbestos exposure, contact a mesthoelioma lawyer today to discuss a potential asbestos lawsuit.


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