Case Report: Rare presentation of pancreatic ductal adenocarcinoma with severe depressive disorder with catatonia

Abstract

Pancreatic cancer is a highly lethal malignancy with symptoms such as abdominal pain, back pain, loss of appetite, bloating, weight loss, jaundice, nausea, vomiting, etc. It has a relatively late presentation, which makes its only potentially curative treatment, surgical resection, impractical for most patients. However, the prognosis is poor despite complete resection. The occurrence of depression and anxiety is rather common in patients with pancreatic cancer and a biological basis for this is suspected, although not studied in detail. We herein report a case of pancreatic ductal adenocarcinoma in a 57-year-old man who suffered from abdominal pain, constipation, and significant weight loss. The computerized tomography (CT) scan and successive endoscopic ultrasound (EUS) guided biopsy with histopathology confirmed a mass arising from the mid-body of the pancreas with tubular and cystic glands lined by moderately pleomorphic columnar epithelial cells. The patient underwent chemotherapy with the FOLFIRINOX regimen. He eventually developed severe depression with psychotic symptoms and catatonia, which further exacerbated the challenges in the management of the malignancy. In spite of widely available therapeutic options for the management of depression described in the literature, the effectiveness of those in pancreatic cancer patients with concomitant depression is not well established. Hence, more studies are imperative in addressing the neuropsychiatric associations of pancreatic cancer and formulating a protocol for their apt management.