Back pain and mental retardation.

UNLABELLED: A 25-year-old African-American male with mental retardation was brought to the hospital by his caregiver with a chief complaint of low back pain for four months, complicated by recent anorexia and weight loss. Lumbar spine x-ray showed spondylosis at L2-L3 with normal sacroiliac joints, hip and femur; MRI showed a fracture of the L2 vertebral body. Consequently he underwent L2 anterior corpectomy with bone graft replacement and fusion. Spinal surgical biopsy revealed large cell neuroendocrine carcinoma with immunostaining studies suggesting lung origin. A chest CT scan showed a large solid mass in the mediastinum.

CONCLUSION

We are reporting a unique case of large cell neuroendocrine carcinoma (LCNEC) of the lung in a nonsmoking young male which presented as low back pain to emphasize the importance of taking symptoms of patients with mental retardation seriously to avoid diagnostic delay.