We begin today's episode with a mystery, a medical mystery in the Texas

lab of Dr. Chelya Marginian. I'm a pathologist and I practice gastrointestinal and liver pathology at Baylor College of Medicine in Houston, Texas.

Marginian gets dozens of biopsy samples each week for urgent assessment.

I actually love it. I am a very visual person. I like to draw and paint. I like colors. You know, looking at tissue, it's actually very

colorful. It's not just, you know, pink and purple and blue. And I see every case is a puzzle.

Solving that puzzle can be a matter of life or death for a patient,

like this one case that arrived in her lab back in September 2022.

It was a very, very striking case.

Marginian put the tissue sample she'd received under her microscope and what she saw alarmed her.

It was predominantly pink because that tissue is pink.

So, you know, I kind of panicked. I'm like, oh my gosh, this is either two things, like it's either

viral hepatitis or it's a drug-induced injury. I was very concerned.

What Marginians saw was serious. injury, I was very concerned.

What Marginians saw was serious, so she got to work.

So then first thing you do, you know, you check in the clinical notes

and see what are the labs, how high they are, what is the

patient taking. So this particular case the patient had very, very high, very abnormal liver function tests, like seven

times normal. She was John's death, she had nausea and vomiting and

abdominal pain.

Marginian went through a process of elimination.

She ruled out the likely culprits that was making this patient sick.

The patient wasn't taking prescriptions, she ruled out some kind of serious liver disease, and it wasn't a virus.

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