Abstract
Medullary renal cell carcinomas are exceedingly rare and essentially uniformly and rapidly fatal. Expeditious diagnosis is crucial. Immediate treatment with a clinical trial or platinum-based chemotherapy is needed for metastatic disease given the aggressive nature of medullary renal cell carcinomas. In this article, we discuss a 24-year-old man with no known significant past medical history who presented with a progressive cough and shortness of breath. After evaluation at an urgent care and four evaluations in the emergency department, the patient was admitted and ultimately diagnosed with metastatic medullary renal cell carcinoma. This case highlights the characteristics, presentation, rarity, and aggressiveness of medullary renal cell carcinoma.