10y/o NM DSH
Originally diagnosed with hyperthyroidism after presenting for anorexia, vomiting, diarrhea. Treated with radioactive iodine. T4 stabilized.
Same symptoms still occurring, U/S performed. IBD vs Lymphoma, triaditis, cholangiohepatitis, multiloculated liver nodule.
Intestinal biopsies were obtained along with mesenteric lymph node, pancreas, and liver. Histopath came back with small cell intestinal lymphoma, intestinal mast cell tumor, multifocal lymphoplasmacytic pancreatitis, and chronic cholangiohepatitis.
Put on chlorambucil & prednisolone. Was doing pretty well on the combo. Got megacolon multiple times, tx with cisapride, lactulose, etc. He started eating normally, gained weight, back to normal happy personality. About a year later he started losing weight again, then was having mini jerk like reactions when loud noises were made. He then had a grand mal seizure. Keppra kept it under control after going to the ER. Blood serum icteric at that time, ER doc didn’t do anything for his liver. Few days later now he is icteric. Next day cardiac arrest.
What happened? Hepatic encephalopathy? Hepatic lipidosis? Did the cancer spread? I’m trying to piece it all together. I didn’t get a necropsy on my boy and I’m just going in circles. His oncologist said he doesn’t think it’s the cancer spreading but I don’t see how that’s entirely possible. Would anything have changed had he gotten a feeding tube, liver protectants, etc. on that day his serum was icteric since his skin wasn’t yet?