We report a 19-month-old Middle Eastern female born to nonconsanguineous parents who presented to the Cleveland Clinic with a history of chronic diarrhea, failure to thrive, dysmorphic facies, and hair abnormalities since birth. She was initially diagnosed with trichorrhexis nodosa via hair sample and a full-thickness sigmoid colon biopsy, which showed an increased number of ganglion cells, mostly immature in both the submucosa and the myenteric plexus. Genetic studies confirmed a diagnosis of trichohepatoenteric syndrome, type 2. In addition, elevated liver function tests and AFP supported a liver biopsy revealing welldifferentiated hepatocellular carcinoma (HCC). Pediatric oncology initially opted for supportive management, for which the patient was placed on total parenteral nutrition (TPN) after several failed attempts at NG tube feeding with chronic diarrhea and emesis. TPN was complicated by multiple catheter-related bloodstream infections, along with continued failure to thrive. (Fig. 2).Two weeks later, the patient's GVHD resulted in multi-organ failure. The patient's family refused to put the patient on dialysis for kidney failure, and the patient ultimately died of sepsis 4 weeks post transplant.