Introduction:

Rare diseases are a particular health problem nowadays. Malignant peritoneal mesothelioma is a case of a rare tumor with nonspecific clinical, being a diagnostic and therapeutic challenge. The family physician should be on alert for the possibility of a rare disease by providing timely guidance and support to the patient and its vulnerable family.

Case report:

78-year-old man, married and retired, with a history of hypertension, overweight, dyslipidemia, benign prostate hyperplasia, and diverticulosis (colonoscopy in 2016). In May 2018, he began complaining of abdominal pain, nausea, anorexia, and asthenia. An initial screening was performed, revealing anemia and elevation of inflammatory parameters, normal urine test, chest x-ray, and upper gastrointestinal endoscopy. Due to complaints, he was sent to the emergency department and admitted for surgery in July. The patient underwent abdominal-pelvic CT, showing mesenteric densification involving the colon and ileum, and underwent antibiotic therapy. Due to progressive clinical worsening, with weight loss greater than 10%, the patient and his wife asked the family physician several times about the diagnosis and symptom relief. The family physician complemented the study with abdominal ultrasonography and, later, an outpatient MRI, after cost-benefit discussion with the patient, wife, and granddaughter, added pericardial effusion. The case was discussed by telephone with the surgical team, and later with the internal medicine team, to exclude autoimmune or infectious disease. Follow-up tests still showed anemia, CRP 91.2mg/dL and normal serology, tumor markers, Mantoux test, cardiac and prostate tests. In December, the patient started complaining of night sweats and fever and was sent to the emergency department and again admitted for further study. He was diagnosed with disseminated malignant peritoneal mesothelioma and palliative treatment was decided. Passed away in May 2019.

Comment:

This case demonstrates the difficulty and diagnostic barriers of a rare disease, the need to support the patient and his family, as well as the importance of the family physician as a link to secondary health care and biopsychosocial follow-up to the patient and family.

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