A Young Athlete Returns to the Baseball Diamond
MT, a 17-year-old high school student, was the star shortstop on his school's baseball team. He hoped to become the next Derek Jeter, and was being heavily recruited by a number of premier colleges. At age 16, his only medical problem appeared to be pimples, for which he took a common anti-acne medication. At a certain point, however—in what is believed to be only the third such case in the world—his entire body began to attack itself. This auto-immune reaction had devastating consequences, including disfiguring wounds over his entire body. After more than a year of failed treatments at a New York-area children’s hospital, he was referred to Johns Hopkins Medical Center. Upon seeing his wounds, the Johns Hopkins plastic surgery team told his family that there was only one group that could solve this medical problem—Dr. Harold Brem's wound healing team.
Under the skilled care of the team's plastic surgeon, it became clear that MT had highly complicated wounds in his back, neck, and ear. These slowly began to improve through a series of skin graft treatments. In February of 2012, however, the wound suddenly worsened and began marching toward his facial nerve, threatening permanent paralysis of his face as well as his carotid artery. MT was readmitted to the hospital with what had become a life-threatening. Beginning on a Saturday and continuing over the next 96 hours, Dr. Brem's wound care team came together to save the young man’s life.
As a first step, the wound team's experienced physician assistants began collecting all of his medical data, including every test that had ever been done. An onsite colleague, who is a leading national expert in auto-immune disorders, ordered a new test that showed MT was having a subtle flair of his granular cytosis, requiring not only high-dose steroids but also an advanced medicine known as a monoclonal antibody that until then had not been commonly utilized. The auto-immune specialist was able to solicit the help of a pediatric oncology team to administer this monoclonal antibody. The medication successfully suppressed MT’s immune system—providing a pinpoint treatment to complement his pinpoint diagnosis.
In addition, a micro-surgeon associated with Dr. Brem's program, performed a unique procedure in which he added human skin cell types called keratinocytes and fibroblasts to cover and protect the endangered nerve and artery. He also did a specific biopsy to determine exactly how the immune system was being attacked. The biopsied tissue was passed along to pathologists, who diagnosed the presence of a new type of cell, called giant cells. Meanwhile, other special stains came back negative, confirming the highly-invasive type of wound this had become.
While this was all taking place, a team of pediatric residents, nurses, pediatricians, and infectious disease consultants were managing the complex antibiotics needed to treat the secondary organisms in MT’s wounds, including the difficult-to-treat methicillin-resistant Staphylococcus aureus (MRSA) bacteria as well as Pseudomonas aeruginosa. Working together, the multidisciplinary group developed a treatment plan that included a series of reconstruction procedures performed in coordination with various members of the wound team.
The multi-faceted approach proved successful, and our wound team was able to deliver on our promise to MT that he would play baseball again. Last spring, his team won the state championship. MT was on the bench with his teammates for the last game, and received a standing ovation during the team's awards dinner.