The case history of Mr T.I. Terminal patient or still curable?

Today we have a somewhat unusual Grand Rounds, because our case presentation, Mr T. I., has a non-identical twin, who also went through a period of ill-health in childhood, but now seems to be pretty fit, and we shall spend some time comparing the two brothers. Mr T. I. is about 25 years old, and at present appears to be in rather a serious state. The chief symptoms are fatigue and confusion, which have followed a period of unusually intense activity. The detailed history reveals that T.I. has never really been free of symptoms, and though his rate of growth was very rapid, especially during his teens, there have been periods of euphoria alternating with depression, and close observers have noted a certain malaise throughout. The laboratory tests have not contributed to the diagnosis, as some appear to suggest robust good health whereas others hint at a terminal state. Mr. T.I., whose full name is Tumor Immunology, is thus a diagnostic and prognostic puzzle. Perhaps a look at the case history of his non-identical twin brother will help us. Curiously, his initials are also T.I., the full name being Transplantation Immunology. This twin also experienced a very sick childhood, especially up to the age of 10, but since then has made steady progress and is now in fair health and holding down a useful job. While his problems were much easier to diagnose, treatment was not straightforward and management options continue to require detailed assessment.