Fool's Gold

A CLINICAL PROBLEM-SOLVING article by Nicholas Leeper from Stanford University School of Medicine, California.
A 20-year-old man presented to the emergency department after a syncopal episode. During the previous 2 weeks, he had had persistent low-grade fever, anorexia, rhinorrhea, and headache. On the morning of admission, he felt weak and then collapsed while walking into a room; he had no other antecedent symptoms. Once he regained consciousness, he reported having dyspnea. In the emergency department, the patient remained hypotensive and dyspneic. Electrocardiography showed a right bundle-branch block with right-axis deviation, a finding that had not been present 8 months earlier.
Two years earlier, the patient had received the diagnosis of stage IV pre–T-cell lymphoblastic lymphoma. Despite a complete remission after induction and consolidation chemotherapy, he had a recurrence within the year.
After the patient's initial presentation with hypotension, syncope, and ECG evidence of right heart strain, the treating physicians pursued the diagnosis of pulmonary embolism. The patient's long-term use of corticosteroids also prompted consideration of sepsis and adrenal insufficiency. In the process of the evaluation, he was found to have cardiomyopathy. A comparison with previous imaging revealed that there had been rapid progression of ventricular-wall thickening; this was immediately recognized to be pathologic and to point to an infiltrative process. Although a recurrence of the patient's cancer was high on the list of suspected diagnoses, the “gold standard” test — endomyocardial biopsy of the right ventricle — was normal.

"Fool's Gold"は、もともと「黄鉄鋼(Pyrite)」の意味で、金と似ていることから比喩的に「見掛け倒し」の意味でも使われる。本ケースでは、"Golden Standard"が見掛け倒しであるという意味が込められている。