What happened, in summary

A previously well man in his mid-60s developed 3 months of progressive neurological and behavioral symptoms. He became anxious and confused, slept very little, and developed muscle twitching, painful spasms, jerking movements, falls, and severe drops in blood pressure when standing. He lost about 3 kg over 2 months but reported no bowel symptoms.

The combination of confusion, sleep disturbance, overactive nerves and muscles, and autonomic problems was diagnosed as Morvan syndrome. Because this syndrome can sometimes be linked to cancer, further investigation was performed. It uncovered an occult tumor at the ileocaecal region.

He underwent en bloc removal of the terminal ileum together with a right hemicolectomy. Pathology showed adenocarcinoma classified as Dukes B, T3N0M0. No cancer was found in the lymph nodes, and the tumor had been completely removed, so no additional chemotherapy or radiation was required.

Several of his central and autonomic symptoms improved significantly after the cancer operation. Fluids and fludrocortisone helped the low blood pressure. Persistent nerve overactivity and pain were treated with IV immunoglobulin for 5 days and later corticosteroids. Recovery was only partial, and some neuromuscular symptoms continued. The cancer was fully resected, node-negative, and did not require further anticancer treatment.

The neurological illness, rather than bowel symptoms, led to the cancer diagnosis. Removing the tumor improved confusion and blood-pressure problems, while nerve and muscle symptoms needed longer immune treatment. He remained cancer-free after resection, while rehabilitation continued for the incomplete neurological recovery.