A patient with Peutz-Jeghers syndrome

A rare, hereditary syndrome is just one of this patient's comorbidities

Maureen, a 54-year-old woman with a history of lifelong atopic asthma, presented with shortness of breath. She smoked 20 cigarettes daily - overall, a 30 pack-year history. 

Her complex medical history included Peutz-Jeghers syndrome, diagnosed when she required laparotomy for small bowel obstruction at age 26.

Upper and lower gastrointestinal endoscopies every two years have been clear of malignancy. 

At age 36, Maureen underwent Nissen fundoplication for severe gastro-oesophageal reflux disease. She developed idiopathic epilepsy a few months after that. She had been fit-free on treatment for some years. 

At age 46, she underwent conservative surgery and local radiotherapy for screen-detected, early stage, hormone receptor-positive, left breast cancer.

She took adjuvant tamoxifen for five years. Other past surgeries included caesarean section, appendicectomy