Diagnostic Overshadowing and Delayed Diagnosis of Thymoma in a Psychiatrically Stable Patient with Complex Psychiatric Comorbidities

Einat Mader*, Eyal Fruchter and Guy Dori

Med-Psych Service, Emek Medical Center, Afula, Israel Rappaport Faculty of Medicine, Technion, Haifa, Israel Department of Internal Medicine "E", Emek Medical Center, Afula, Israel

^*Correspondance to: Einat Mader 

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Abstract:

Context: Thymoma is a rare anterior mediastinal tumour and an uncommon cause of fever of unknown origin (FUO). Diagnosis may be particularly challenging in patients with psychiatric illness due to diagnostic overshadowing and anchoring bias. Case Presentation: A 36-year-old woman with schizoaffective disorder, autism spectrum disorder, eating disorder, and post-traumatic stress disorder presented with eight months of intermittent fever, night sweats, weight loss, and multiple systemic symptoms. Previous extensive investigations were non-diagnostic, and her symptoms were attributed to psychosomatic causes. Referral to an integrated Med-Psych service prompted chest CT, which revealed an anterior mediastinal mass. Thoracoscopic resection confirmed a WHO type AB thymoma. Postoperatively, she had complete symptom resolution and full functional recovery. Conclusion: This case demonstrates how cognitive bias, stigma, and fragmented care can delay recognition of rare organic disease in psychiatrically stable patients. It underscores the need for comprehensive, unbiased, and multidisciplinary assessment to ensure timely diagnosis and treatment.

Keywords:

fever

Cite the Article:

Mader E, Fruchter E, Dori G. Diagnostic Overshadowing and Delayed Diagnosis of Thymoma in a Psychiatrically Stable Patient with Complex Psychiatric Comorbidities. Ann Clin Case Rep. 2025; 10: 2774..