Hepatocellular carcinoma (HCC) is a solid tumor of the liver and one of the most common primary tumors of the liver. Lifestyle being a major risk factor for the development of HCC makes it a major public health concern worldwide. HCC rarely infiltrates the gall bladder because it rarely destroys the muscle layer and collagen fibers of the gallbladder wall. We report here a rare case of hepatocellular carcinoma that invaded the gallbladder and was initially misdiagnosed as primary gallbladder malignancy invading the liver.

Baclofen, a muscle relaxant is primarily excreted by the kidneys. We present the case of a 60year-old male who developed acute delirium, visual hallucinations, and behavioral changes after he took a friend's prescription of baclofen for pain relief. There was immediate improvement after dialysis, and multiple sessions of hemodialysis led to complete resolution of symptoms. A high suspicion for pharmacological causes of delirium is needed in the end stage renal disease (ESRD). Baclofen is known but under recognized cause of acute delirium in ESRD patients. We discuss the pharmacokinetics of baclofen. We suggest reducing dose or preferably avoiding use of baclofen in ESRD patients, especially the elderly.