Case Report

A 65-year-old Caucasian male with no significant pastmedical history presented to the emergency department with an unintentional 44-pound weight loss over a four-month period. The weight loss was preceded by fatigue and anorexia,which had been increasing for approximately eight months.In addition, he noted numbness and tingling of his hands and feet that began over the same time period. The patient was initially treated for depression with sertraline by his primarycare physician. However, his symptoms persisted without significant improvement. An initial workup at outside hospital one month prior to presentation included an abdominal CTscan, which revealed a mass in the pancreatic head suggestive of a pseudocyst. He was also treated for Lyme disease with a course of doxycycline based on a rash finding on his left thigh.Lyme serologies were negative. He denied fever, chills, nightsweats, changes in bowel habits or stool character, dysphagia,odynophagia, abdominal pain, cough, or shortness of breath.He also denied focal weakness, changes in speech, or changes invision. He has no known drug allergies. Medications included sertraline for depression, zolpidem and diphenhydraminefor sleep. He denied tobacco or illicit drug use. He drinks alcohol occasionally. Family history was non contributory, with no history of malignancy, neurodegenerative or endocrine disorders.