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A 14-year-old lymphoma patient presented to the ER with acute dystonia just 48 hours after chemotherapy—triggering a broad differential diagnosis including CNS involvement, metabolic imbalance, and drug toxicity. After careful evaluation, the culprit was identified as metoclopramide-induced extrapyramidal symptoms (EPS), a rare but important clinical mimic in oncology patients. This case highlights the importance of medication review and vigilance for adverse drug reactions in cancer care. Early recognition can prevent unnecessary investigations and provide rapid symptom relief with appropriate treatment.
#Lymphoma #Oncology #ExtrapyramidalSymptoms #AcuteDystonia #Metoclopramide #ChemotherapyComplications #CancerCare #MedicalEducation #DoctorLife #ClinicalCase #RarePresentation #ERMedicine #PatientSafety #AdverseDrugReaction #MedEd

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Transcript
00:00Asalaamu alaykum
00:01So, yesterday I posted this case
00:04What do you people think of the diagnosis?
00:08So, this case was in emergency.
00:11It was quite interesting.
00:13So, I thought it is worth sharing.
00:15So, a 14-15-year-old child
00:17with lymphoma diagnosis
00:19took 2 days before chemotherapy.
00:23After 2 days, she comes in emergency.
00:26And the child is like this.
00:30She is looking at her eyes.
00:31She is looking at her eyes.
00:32Abnormal posturing is still happening.
00:35And my fellow doctors,
00:39we started seeing a case together.
00:43So, whenever you have cancer,
00:46there are some common things
00:48in your mind
00:49whenever you are experiencing
00:51any neurological thing.
00:53So,
00:55I have seen her powers and other powers
00:59were fine.
01:00Ordinations were fine.
01:02The child had no more neurological deficit.
01:07It was vitally stable.
01:09So,
01:11in this case,
01:12our differential diagnosis
01:13started to be
01:14that first of all,
01:15it can be either brain metastasis,
01:18it can be raised intracranial pressure
01:20due to any cause.
01:21It can be a space occupying lesion
01:23or a traumatic brain injury.
01:27Secondly,
01:28in this case,
01:28you have a seizure disorder
01:29in your mind.
01:32Because,
01:32this condition
01:33we call acute dystonia
01:35that's the problem.
01:36I have struck me
01:39that no neurological signs
01:41are not
01:41in the existence.
01:41Vitaly child is completely stable.
01:44So,
01:44are we missing something?
01:46I have to think about it
01:48and so much
01:49we have to think about it.
01:49Investigations,
01:50obviously,
01:51we have to send off
01:52which we have suspected
01:53had to be suspected.
01:53Meningitis,
01:55or Encephalitis.
01:57We have to be suspected
01:58of the investigation.
01:59We send all of those things
01:59to be suspected.
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