Misdiagnosis of Pineal Gland Tumor leads to death of a young girl - Case Report

The weekend is almost here and I am excited about it for which I am sure many of us are also vehemently looking forward to it. January is wrapping up and we will soon be entering the month of Love, I hope we are ready for love?

Anyway, I hope we are all doing amazing and having great times at our workplaces and wherever we find ourselves? As I tend to do quite often, as a health enthusiast and an Optometrist I love to talk about the eye and the various conditions that tend to jeopardize our health every now and then.

Today though, I want to talk about a case that was overseen by my colleague for whom I consulted, it is not a happy ending however I just want to share this with us, the purpose is not to scare you but to awaken the alertness in all of us when it comes to our health and our eyes.

The eye is such an amazing tool in diagnosing many health conditions if you know where to look and what to look for. So I do hope you enjoy the read, kindly leave your questions or discussions below. Alright, let's dive right into it then.

An 11-year-old girl presented to the hospital with complaints of severe headaches for which she was admitted and was started on analgesics to manage the pain. She has been experiencing this for quite some time now and now it's become unbearable so she had to come in. Shortly after admitting her, she started to have difficulty stretching herself to a full length, which had also become quite painful.

During the lab tests, her physician at that time ordered a Urine Pregnancy Test which came out positive, this was quite unfortunate for her because it stopped her nurses and her general physician from doing other recommended tests to find out or rule out possible differentials. She was also not referred for an Ophthalmologic consult as was the ideal requirement in situations of severe headaches.

In the next couple of days, she developed an acute onset of bilateral esotropia (When the eyes become deviated and look inward instead of straight), this prompted her primary caregiver to seek a consultation with the Ophthalmology department for which the attending Optometrist immediately asked a head CT scan to be done, the question was why the long wait, she should have been to the eye department a long time ago but better late than never.

Examination of the fundus reveals a swelling of the Optic Nerve head which suggests that pressure has been mounting up within the brain space and based on the history we can say this has been going on for quite some time now. When the CT results came out hydrocephalus was present and an enlargement of the pineal gland was observed. Most focused test scans were ordered and it was concluded the child had a malignant tumor of the pineal gland.

It was time to seek an oncology consultation and see what best could be done, but before anything could be done about the diagnosis she passed away the next morning. The reason why her Urine tested positive for pregnancy was because of the tumor which was causing the release of hormones that would let a pregnancy test come out as positive. It was a sad day indeed and an opportunity to save a life was missed.

Further Reading

_{Borruat FX. Céphalées et oeil [Headaches and the eye]. Rev Med Suisse. 2007 Feb 14;3(98):422, 424-6, 429-30. French. PMID: 17378357.}

_{Owlia M, Yu L, Deible C, Hughes MA, Jovin F, Bump GM. Head CT scan overuse in frequently admitted medical patients. Am J Med. 2014 May;127(5):406-10. doi: 10.1016/j.amjmed.2014.01.023. Epub 2014 Feb 6. PMID: 24508413.}

_{Ying Z, Ge M, Yang W, Cai Y, Zhang N. Pineal anlage tumor: a case report and the literature review. Childs Nerv Syst. 2023 Feb;39(2):353-358. doi: 10.1007/s00381-022-05763-6. Epub 2022 Dec 6. PMID: 36471063.}

_{Sapède D, Cau E. The pineal gland from development to function. Curr Top Dev Biol. 2013;106:171-215. doi: 10.1016/B978-0-12-416021-7.00005-5. PMID: 24290350.}