An Immaculate Deception: Persistently Elevated Serum β-Hcg in Metastatic Signet Ring Cell Gastric Adenocarcinoma

Background: Persistent elevations in beta-human chorionic gonadotropin (beta-hCG) can be an ominous sign of both trophoblastic and non-trophoblastic malignancies. The absence of a clearly identified etiology of beta-hCG elevation warrants pursuit of further diagnostic testing to determine the source of ectopic beta-hCG. Case Report: A virginal 26-year-old woman with past medical history significant for persistently elevated beta-hCG presented to our Emergency Department with shortness of breath, pleuritic chest pain, nausea, and vomiting, and was found to have widely metastatic gastric signet ring cell adenocarcinoma. Why Should an Emergency Physician Be Aware of This?: Although elevated serum beta-hCG is a generally a marker of pregnancy, beta-hCG elevation without clear etiology necessitates ruling out other insidious processes. Failure to maintain and pursue a broad differential in the context of unexplained elevations of beta-hCG can result in catastrophic missed or delayed diagnosis. (C) 2022 Published by Elsevier Inc.