Case Records of the Historical Grand Rounds:
Case 6: Walter Payton

Walter Payton (1953-1999) playing for the Chicago Bears

One of the greatest players in the history of American football, Walter Payton was known for his exceptional skill and toughness, missing only a single game during his record-setting thirteen seasons in the NFL. He was also known as a very kind and generous man off the field, earning him the nickname “Sweetness” among his fans and teammates. Twelve years after his retirement, he held a press conference announcing that he was suffering from a rare disease and would need a liver transplant to survive. His doctors commented that the condition had caused Walter to lose a lot of weight, and “wasn’t related to alcohol, steroids, hepatitis, or immune deficiency.” It also went unnoticed for years before he presented with weight loss, fatigue, and most likely pruritus. As the disease progressed he became increasingly incapacitated and needed stents placed in his common bile duct.

In his last few months, Payton become a strong advocate for organ transplantation and began several campaigns to raise awareness and encourage people to register as donors. While awaiting an organ at the Mayo Clinic, Walter was further diagnosed with a malignancy that is a known complication of his condition. After he passed away later that year, the issue of organ donation became a major headline nationwide, and there was a surge in the number of people trying to register as donors. A foundation created during his lifetime continues to fight for this cause today. What condition did he have and what was the malignancy he died from?

Answer (highlight to see):
Primary sclerosing cholangitis, complicated by cholangiocarcinoma.

Case Records of the Historical Grand Rounds:
Case 5: Ernest Hemingway

Ernest Hemingway, 1899-1961

In 1960, after a 40 year career as an inspired author and war reporter, Ernest Hemingway arrived at the Mayo Clinic seeking treatment for his severe depression. Treatments were limited at the time, though his case was so severe that his doctors decided to try several rounds of electric shock therapy. Unfortunately their attempts did more harm than good, and only served to worsen his already declining memory, ending his writing career for good. They also happened to discover that Hemingway had a whole host of other medical problems that demanded attention. For many years he suffered from severe arthritis that was particularly advanced for a man of his age. He also had a long history of diabetes and had clear signs of cirrhosis. At the time his doctors thought years of alcoholism were likely responsible, though no unifying diagnosis was made. During his two month stay at the Mayo Clinic, he was also diagnosed with a heart condition that today would likely be labeled "congestive heart failure with preserved ejection fraction".

In 1961, Hemingway returned for another round of electric shock therapy which was again ineffective. Later that year he committed suicide as a result of his longstanding depression, chronic pain, and declining mental capabilities. While none of his individual problems are particularly rare, medical records released 30 years later reveal a single unifying diagnosis made shortly before his death. It is something surprisingly common among those of Northern European heritage, and may even have contributed to his depression and cognitive decline. What is it? Also, which characteristic type of arthritis may he have had?

Answer:
Hemochromatosis (diabetes, cirrhosis, restrictive cardiomyopathy, iron deposits in the brain). These patients are particularly prone to pseudogout.