Transcription

• Speaker #0

  This is Case Encounters, a journey into the true medical mysteries solved by pathologists, like the Harris family's race against time.

• Speaker #1

  Consider an average, happy American family. Hardworking, well-educated parents of three bright young children. Grandma. who's a part-time librarian, has been living with them since her husband passed last year. They're all active, health-conscious, and engaged in the community. When their middle child, four-year-old Lena, fell ill a few weeks ago, they all thought she picked up a bug at daycare. What transpired since then was a parent's worst nightmare, and a hard-to-swallow lesson for the whole family.

• Speaker #2

  Your mom's okay to look after Kai and Thomas for a while, right? I don't know how long we'll be here.

• Speaker #3

  Yep. She's not working this week, so it should be fine.

• Speaker #4

  Mr. and Mrs. Harris? Hi, I'm Dr. Quinn. Who do we have here?

• Speaker #2

  Hi, Dr. Quinn. Nice to meet you. This is Lena. She's been sick with the bug for the past three weeks and seems to have gotten much worse. Now she can't breathe very well and sleeps all the time, like this. So still.

• Speaker #4

  Hmm, okay. I'm just going to have a listen to her breathing. It is quite shallow. And her abdomen's distended.

• Speaker #2

  Is it serious?

• Speaker #4

  Well, she doesn't have a fever. She is quite dehydrated. And she's got some fluid around her right lung and in her belly. Hmm, and her liver's enlarged. You have two other kids? Are they feeling okay? Anyone else in the family been sick?

• Speaker #3

  The other two are fine. So is my mom. She lives with us.

• Speaker #4

  Okay. Well, let's get this figured out. I'd like to admit her so we can get some IV fluids and run some tests. A nurse will be by for the blood work, and then we'll take her for a chest x-ray and an ultrasound of her liver.

• Speaker #2

  She's so little for something so serious. I'll stay with her tonight.

• Speaker #4

  Kids are stronger than we give them credit for. We'll get a popsicle in here for her. That'll make things better.

• Speaker #1

  Some choices feel wholesome, harmless, like an ice-cold popsicle or a warm cup on a cold day. Trouble is, we don't always know what's hidden in those choices or how our bodies will deal with them.

• Speaker #4

  Good morning, Mr. and Mrs. Harris. Hope you all managed to get a little rest. Lena's labs and imaging results are back. Let me walk you through what we're seeing.

• Speaker #3

  Okay. Thank you.

• Speaker #4

  Her liver enzymes are high. That tells us her liver cells are damaged. Her albumin is low, which means her liver isn't making enough of the protein that keeps fluid in the blood. That's why her belly is swollen and her blood isn't clotting the way it should. All of this is telling us that her liver is under quite a bit of stress. The best way to understand what's happening is to do a liver biopsy, but because her blood isn't clotting well, we can't right now. The risk of internal bleeding is just too high.

• Speaker #3

  So what now? Are you thinking liver failure? Cancer? She's too young for this.

• Speaker #4

  Unfortunately, right now, it is looking like early liver failure. At the moment, though, our transplant team doesn't think this is a case for transplant. Not yet. We all want to be sure this isn't something like a virus, a reaction to something she ate or was exposed to. If this is the case, There's reason to believe this might be reversible.

• Speaker #2

  A reaction to something? Like a poison? Or an allergy?

• Speaker #4

  Kids can get into all kinds of things in everyday places. Have any of the children at her daycare or playgroup been sick? Are the cleaning supplies all behind child lock cupboards? Any foreign plants in the house?

• Speaker #2

  We definitely know if any of the other kids were sick. We pack all her snacks and send bottled water with her every day. Fruit, string cheese. crackers, nothing weird. She doesn't even like juice.

• Speaker #4

  Does she take vitamins, supplements? Could she have any access to medications in the house?

• Speaker #3

  No, she doesn't take anything. We're really careful with all our medications. They're up in the medicine cabinet where the kids can't get them.

• Speaker #5

  I'm sorry to interrupt, Dr. Quinn. Lena's grandmother is here. She brought the other two kids in. She says they're feeling sick. sick too.

• Speaker #2

  What? What do you mean sick? Do all three of them have this?

• Speaker #5

  It sounds like the same symptoms as Lena. Nausea, vomiting, and fatigue. We're bringing them both up to Pete's now.

• Speaker #1

  One child's unexplained illness is a puzzle. Three is a pattern. And sometimes, a pattern can reveal the shape of a bitter pill to swallow.

• Speaker #3

  Mom? Can you think of anything the kids would have gotten into? Have they been playing in the basement or anything?

• Speaker #6

  No, Danny. I take them to the same park as all their friends. And it's been so chilly and rainy, we've mostly been staying home, reading stories, and sipping tea.

• Speaker #4

  Okay, Mr. and Mrs. Harris, it seems the boys are both showing early signs of what we're seeing in Lena. Mild swelling of their bellies, Thomas is jaundiced and his liver swollen, but Kai doesn't seem as unwell. I've ordered labs and ultrasounds for both of them, but right now we're looking at anything that they've shared or had access to. Food, environment, medications? No,

• Speaker #2

  like we said, no supplements, no medications. We're living in an older house we renovated. Could it be something in the pipes or attic?

• Speaker #4

  Okay, but only the kids have been sick? Have the rest of you been unwell at all?

• Speaker #3

  No, we've all been fine.

• Speaker #4

  Okay, well at the moment Thomas is stable. and if his blood work looks okay, we'll do a liver biopsy. It'll be a bit painful for him, but it could give us the answers we need for Lena, and it could help us prevent the boys from getting worse. I've put a rush on his tests.

• Speaker #2

  A biopsy? Oh boy. Okay, if it'll help us figure out what's happening, let's do it.

• Speaker #4

  If it's something they've been exposed to at home, they may start getting better on their own here. I've put both the boys on fluids and they're both sleeping. You can go in and see them, and I'll go check on Lena.

• Speaker #1

  Children have no choice but to move through the world on trust. They eat what they're given, breathe in the air that surrounds them, absorb a thousand choices that were never theirs to make. And when something goes wrong, they can be unfortunate canaries in the proverbial coal mine.

• Speaker #4

  It's nice and quiet here.

• Speaker #7

  Peace and pathology make a great combination. I love the kids, but can't imagine focusing on anything with the noise around me. You're welcome to ruin my ambience, though.

• Speaker #1

  Enter Dr. Celia Grange, pathologist and one of medicine's unsung heroes. No white coat, no stethoscope. Her patients never even get to meet her. She doesn't treat... the illnesses, she uncovers them one slide and one clue at a time.

• Speaker #4

  I've got three sick kids upstairs, Celia, and no clear cause. The girl's not improving. She's tired and seems to be getting worse. The good news is the boys seem to be stable at the moment, but I'm running out of ideas. Can you tell me what we're seeing?

• Speaker #7

  Sure. Let's have a look on the big screen. The architecture is preserved. No massive cell or tissue death. But look here. Around the central veins. There's narrowing. And some of them are completely obstructed.

• Speaker #4

  So it's vascular.

• Speaker #7

  Yep. Blood's backing up. Hepatocytes are dying off downstream. And when they start to die, everything else begins to break down. So it's not viral. And it's not looking autoimmune.

• Speaker #4

  Oh, are you thinking a toxin?

• Speaker #7

  I am. Something they ate or drank. So... This kind of pattern shows up in exposure to pyralizidine alkaloids. It's a kind of plant toxin, and I saw this in a case report a couple months ago.

• Speaker #4

  From what? Contaminated food or water?

• Speaker #7

  No, it's not a typical food contaminant. Usually it's herbal teas, natural remedies. They can be pretty toxic, especially in young children.

• Speaker #4

  Hmm, the parents said they don't give anything like that. No meds, no supplements.

• Speaker #7

  Well... They might have gotten into something on their own somehow. Or someone gave them something they thought was harmless.

• Speaker #4

  Okay. Well, thanks, Celia. I'll go back up and talk with them. I'll probably be back, though.

• Speaker #1

  Some truths hide in the blood. Others in the roots, leaves, and kitchen cups of good intentions. And the pathologist, with only a slide and a stain. begins to trace the story back to its source.

• Speaker #4

  Mr. and Mrs. Harris, how's Lena doing?

• Speaker #2

  She doesn't seem to be getting worse, but I'll- So not better. We just came down from seeing the boys. They seem about the same as well.

• Speaker #4

  Okay, I'll go up and check on them shortly. I just came from the lab and what we're seeing is a bit concerning. Thomas's biopsy shows signs of veno-occlusive disease. It's a rare liver condition where a toxin kills off liver cells and then the whole system just starts to shut down.

• Speaker #3

  Toxins? Like what? Mold? Lead?

• Speaker #4

  More likely something he ate. What we're seeing fits with exposure to a group of plant compounds called pyralizidine alkaloids. They're found in some herbs and teas. It's likely this is also what's happening with Lena and Kai. Are you sure there isn't something new they've been eating or drinking?

• Speaker #6

  Wait, herbal teas?

• Speaker #4

  Yes. Do you know something, Ada?

• Speaker #6

  Oh, no. Mayor, Danny. I've been letting them have some of my flower tea. When I make it for myself, that yellow flower tea, Alice down the block grows. It helps with my digestion. All the ladies in the book club drink it.

• Speaker #3

  Mom

• Speaker #4

  Do you still have some of that tea or the plant at home?

• Speaker #3

  I'll bring it back. I can go now.

• Speaker #4

  Morning, Dr. Grange. I wanted you to know, we figured out what was happening with the Harris kids.

• Speaker #7

  Oh?

• Speaker #4

  Yep. Tea. The grandmother had been sharing her herbal digestive tea with them. Yellow flowers. A woman down the street shares it with the neighborhood book club.

• Speaker #7

  Let me guess. Senecio?

• Speaker #4

  Yes. Longelolobus. Does that ring a bell?

• Speaker #7

  Threadleaf. Grounsel. One of the worst. Cute little thing and full of pyralizidine alkaloids. They're like a slow poison. They scar the liver's tidy veins, trap blood inside, and over time, the liver gets choked from the inside out. We've seen a few cases come through in the past year. First time we've seen it in kids, though.

• Speaker #4

  Yeah, she had no idea it would hurt them. Poor woman. All those ladies are drinking it.

• Speaker #7

  That's the trouble with these remedies that skip the pharmacy. No dosing, no warnings. What's harmless to grandma can, well, do this to a kid.

• Speaker #4

  Yeah, the grandmother feels awful. They're all getting better now, though, thankfully. But they'll be with us for a few more weeks.

• Speaker #1

  We like to think we've outsmarted medicine, that nature seems like a healthier, wiser choice. So we chase answers in fields and cupboards, in old jars and... pretty petals, but not every cure is a kindness. Sometimes a sweet remedy from a pretty prairie flower can take root in our trust and bloom into harm we never expected.

• Speaker #0

  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 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, 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 Sorgen. Written by Paige Freeborn for Studio North.