A healthy forty-five year-old man awoke to find he had trouble speaking. At the emergency department he underwent an urgent CT scan of his brain showing multiple masses in his brain the largest of which was about an inch in diameter. A chest x-ray showed a spot in his lung, compatible with either infection or a tumor, and he was given the presumptive diagnosis of lung cancer and brain metastases. He had never smoked and had no history of asbestos exposure. He had no fever.
He was admitted to the hospital and started on large doses of steroids to reduce the swelling in his brain. His speech improved. A lung biopsy, done to confirm the presence of malignancy, showed only mild inflammation without cancer cells. Repeat biopsy showed the same thing. He was discharged with instructions to taper his steroids and follow up with the oncologist who had seen him in the hospital.
Shortly after discharge his speech grew dramatically worse and he developed a fever. He was readmitted to the hospital. Repeat CT scan showed dramatic enlargement of the brain lesions (see attached picture showing several CT slices of his brain). He underwent emergency craniotomy (exploratory brain surgery) and was found to have multiple brain abscesses, with pus coming from several of the lesions. He was placed on large doses of antibiotics and improved, but his speech never returned. He is now totally incapacitated by his inability to talk. His family sued the hospital and all of the doctors involved in his care, including the oncologist who saw him once during his first admission.
At trial, the experts trying to help the hospital and doctors testified that this case represented the “perfect storm” of misdiagnosis: a spot on the lung with multiple brain lesions is lung cancer almost 100% of the time. Brain abscesses are rare and typically occur in people with extremely damaged immune systems, e.g., with AIDS or following ultra-high-dose chemotherapy and bone marrow transplantation. They are almost never seen in previously healthy people. The jury was unconvinced and awarded the man $3.5 million; the oncologist was exonerated and no money was paid on his behalf.