Strange and relatively sudden symptoms in a 27-year-old man implied evidence of a rare paraneoplastic syndrome. The patient presented to the emergency department with syncope. He had been completely healthy until 6 weeks earlier when he noticed a mild sensation of lightheadedness on standing. Over the next several weeks, this was accompanied by tunnel vision, palpitations, dyspnea, dry mouth, diaphoresis, and a sensation of flushing, all of which resolved upon recumbence. His first syncopal episode occurred 3 weeks prior to presentation. He became lightheaded and lost consciousness for several seconds. Although he awoke quickly without residual symptoms, from that point onwards, he experienced syncopal episodes with complete loss of consciousness up to 4 times a day.
In addition, he reported constipation, loss of appetite, and an unintentional 50-lb weight loss over the previous 6 months. His past medical history was significant only for a faint pruritic rash that had appeared on his lower extremities 6 months prior. This was diagnosed as cutaneous mastocytosis via skin biopsy.
To read this article in its entirety and to view additional images please visit our website.
–Cyndya Shibao, MD, Prasuna Muppa, MBBS, Matthew W. Semler, MD, Amanda C. Peltier, MD, Italo Biaggioni, MD
This article originally appeared in the April 2014 issue of The American Journal of Medicine.
