Transcription

• Voiceover

  This is Case Encounters, a journey into the true medical mysteries solved by pathologists. Like the case of Lyle Booker, a 32-year-old otherwise healthy man suffering from an inexplicable and painful affliction.

• Sage Whitlock

  Consider a man 30 years of age, healthy. well-kept, living a life of modern conveniences. His days are tidy, routine, and by all accounts, unremarkable. But somewhere, in the overlooked quiet of this routine, between folds of tissue and fibers too small for the eye, something foreign took root. It wasn't just a sore spot on the body, but a blind spot in our understanding of nature. and what it means to be too clean. Lyle Booker appeared in a dermatology clinic. His complaint? Tender sores, small, stubborn lesions. that clung to the borderlands of the body. Back there, on the skin where the sun doesn't shine, is anus. And they'd been there for eight months. No fever, no chills, no trauma, no history of bowel disease. Just two tiny, painful bumps that wept, scabbed, and seemed determined to stay.

• Dr. Daniel Frost

  No fistulas, no hemorrhoids, even the colonoscopy came back clean.

• Lyle Booker

  They're a big problem, Doc. And honestly, kind of embarrassing.

• Dr. Daniel Frost

  Well, looks like you've got an infection. It's hard exactly to say how, but we'll get you started on some antibiotics. And we'll see you back here in a month if it hasn't cleared up.

• Sage Whitlock

  The man left with a bottle of doxycycline and a sliver of hope for relief. But the human body, once wounded, doesn't give up that easily. It protests. It resists, and when something doesn't belong, it festers. A month passed. Mr. Booker's pain on his backside eased, but the lesions remained. One of them is now ripe for removal. and a routine punch biopsy is exactly what the doctor ordered. Cut, retrieve, preserve, and see if the folks at the pathology lab can solve this one. Enter Dr. Camille Ortiz, pathologist. Not a fixer, but a finder. The kind who doesn't chase symptoms, but patterns. Quiet, methodical and patient enough to let science reveal the secrets a body hides. Beneath the lens, something strange. A garden of inflammation.

• Dr. Camille Ortiz

  Granulomas. Foreign body giant cells. What is this?

• Sage Whitlock

  Granulomas. Little clusters of immune cells. Like the body building a wall around something it can't get rid of. Then came the kicker, odd, pink, circular structures, embedded in the skin, pale, glassy, no bacteria, no parasites, no tumor, just rings, organic, natural, foreign. They're called hyaline rings, little structures that lit up like stars in the night. That is. when Dr. Ortiz looked for plant fibers. Dr. Ortiz searched the literature. Rare entities. Hidden corners of dermatology. She checked and double-checked the slide. And then it struck her.

• Dr. Camille Ortiz

  Pulse granuloma.

• Sage Whitlock

  A reaction. Not to infection. Not to cancer. But to plants, yes, plants, cellulose, the stuff leaves and legumes are made of, known to infiltrate the mouth, the gut, but the perianal skin? How? Could it be food? Seeds? A wayward being?

• Dr. Daniel Frost

  So we have a working theory, Mr. Booker. Have you had any trauma, any accidents, or any exposure to plant matter?

• Lyle Booker

  No, sir. No trauma. No gardening mishaps. In fact, I make sure to keep myself extra clean, you know, with baby wipes. Every day, the all-natural, biodegradable, plant-based kind.

• Sage Whitlock

  And there it was, baby wipes. Innocuous, gentle, natural. But beneath the soothing language of eco-friendliness lurked the true culprit, Lyocell, a soft fiber made from wood pulp used in all-natural baby wipes. And under enough pressure, like persistent wiping, it splinters. Microfragments. Invisible to the naked eye. Capable of lodging deep into microscopic tears in the skin. Like a splinter. And once they get in, they can't get out. And don't dissolve. They wait. Until the immune system takes notice. and begins its slow, focused war on the intruder. Two months later, after a switch to a gentle soap and water, Mr. Booker's lesions resolved. No reoccurrence, no scarring, and the patient, now wiser, returned to ordinary life with ordinary toilet paper. But the case lives on, unfortunately seared in our memories.

• Lyle Booker

  They're a big problem, Doc.

• Sage Whitlock

  This was a rare occurrence, triggered by care, not neglect. Not by infection, but by hygiene. A poetic irony, nature reacting to nature. Our patient's body wasn't under attack by a malicious foreign invader, but a well-meaning, gentle visitor. A not-so-subtle warning that even the purest things can go astray when they end up where they don't belong.

• Voiceover

  You've been listening to Case Encounters. This story is inspired by a true medical mystery solved through collaboration, curiosity, and a pathologist. Names and locations are fictitious. Until next time, stay curious. The voices you just heard are those of real pathologists, the people who work long days and even longer weeks to solve medical mysteries big and small. To learn more about the work pathologists do for patients, visit yourpathologist.org for a full list of the pathologists featured in this episode and those who advised the creation of this story. Please visit the show notes. Case Encounters is a production of the College of American Pathologists. Creative support, Studio North. Produced and directed by Natalie Gregory. Sound design, editing, and original music by Jake Sorgan. Written by Paige Freeborn for Studio North.