Season 1
Episode 17 - Role Model
Brief Plot Summary
Senator Gary Wright vomits and collapses after a speech and is found to have no reflexes. An MRI prompts House to perform a brain biopsy, which reveals toxoplasmosis, a common fungi that can only manifest as a lesion when the patient has AIDS. However, consecutive HIV tests confirm that the senator suffers from something else. Hairy cell leukemia is ruled out after Wright tests negative for virii like HTLV and has normal expression of interleukin 2 receptors. However, Wright is positive for Epistein Barr virus (EBV), which, when coupled with phenytoin that he took as a child for an epileptic seizure, could lead to common variable immunodeficiency disease.
Senator Gary Wright vomits and collapses after a speech and is found to have no reflexes. An MRI prompts House to perform a brain biopsy, which reveals toxoplasmosis, a common fungi that can only manifest as a lesion when the patient has AIDS. However, consecutive HIV tests confirm that the senator suffers from something else. Hairy cell leukemia is ruled out after Wright tests negative for virii like HTLV and has normal expression of interleukin 2 receptors. However, Wright is positive for Epistein Barr virus (EBV), which, when coupled with phenytoin that he took as a child for an epileptic seizure, could lead to common variable immunodeficiency disease.
Diagnosed Disease: Common Variable Immunodeficiency Disease (CVID) - CVID is a genetic condition in which the B-Cells of the immune system, the ones responsible for making antibodies, are defective and cannot perform their role. Due to this, a patient can contract the same infection multiple times because the body is unable to recogonize the old virus because it doesn't have any antibodies. However, in the senator's case, he was not born with the condition. Instead, it was acquired with the combination of his EBV infection and the phenytoin he took for epilepsy.
SymptomsRecurrent infections of the respiratory tract, ears and sinuses; breathing problems; and gastric tract infections
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CausesUsually a genetic disorder; however, as seen in this episode, it can be acquired.
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TestsA blood test can show low levels of antibodies in the body, which can be a sign that the paitent has CVID.
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Treatment/CureTreatment can be intravenous anti-body injections to help fight and prevent infections. For the senator, treatment was simple retro-virals to get rid of the EBV infection and thus get rid of the CVID.
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Source Links: NIH Page
Episode 18 - Babies and Bathwater
Brief Plot Summary
Naomi Randolph is 39 has had 3 miscarriages and is currently pregnant. She is admitted after collapsing outside of her car. Her condition worsens and she can't swallow and begins to have pre-term labor during the MRI. She begins to have problems in her kidneys and her liver as well. The team confirms pre-eclampsia. An x-ray of her chest reveals a 3cm mass in her right lung indicating small cell lung cancer, which manifested as a paraneoplastic syndrome by first affecting other organs. She waits to perform a C-section to save the baby but then dies at the operating table.
Naomi Randolph is 39 has had 3 miscarriages and is currently pregnant. She is admitted after collapsing outside of her car. Her condition worsens and she can't swallow and begins to have pre-term labor during the MRI. She begins to have problems in her kidneys and her liver as well. The team confirms pre-eclampsia. An x-ray of her chest reveals a 3cm mass in her right lung indicating small cell lung cancer, which manifested as a paraneoplastic syndrome by first affecting other organs. She waits to perform a C-section to save the baby but then dies at the operating table.
Diagnosed Disease: Small Cell Lung Cancer and Paraneoplastic Syndrome - This cancer is a very fast-spreading form of cancer, which is a condition where abnormal cell growth is uncontrolled and these cells become malignant. It is slightly more common in men than in women and can many times manifest as a paraneoplastic syndrome. This is a disease or symptom that is consequence of the cancer, but is located far from the cancer's site.
SymptomsMetastisis (spread of cancer), airway blockage, fluid build-up, paraneoplastic syndrome, eventually leads to death.
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CausesGenetic pre-disposition; however, prolonged exposure to carcinogens such as cigarettes increase the risk.
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TestsChest X-rays and CT scans are the best ways to detect tumors.
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Treatment/CureUsual cancer treatments are given such as chemotherapy, radiation, and surgery. However, due to the malignancy and metastasis rate of small cell cancer, it is usually terminal even when caught early.
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Source Links: Cancer.gov, NIH Page
Episode 19 - Kids
Brief Plot Summary
After completing her 10m dive with blurry vision, Mary Carroll resurfaces to find that a man has collapsed. The people from the competition are rushed to hospitals as a preventative measure of an epidemic. A lumbar puncture reveals no infections, but Mary has started bleeding from her mouth. Bone cancer tests negative, but she begins to have periodic absence seizures. They do surgery for bleeding in her temporal lobe. Her blood cells are coagulating into small clots due to pregnancy, a condition called Thrombotic thrombocytopenic purpura (TTP).
After completing her 10m dive with blurry vision, Mary Carroll resurfaces to find that a man has collapsed. The people from the competition are rushed to hospitals as a preventative measure of an epidemic. A lumbar puncture reveals no infections, but Mary has started bleeding from her mouth. Bone cancer tests negative, but she begins to have periodic absence seizures. They do surgery for bleeding in her temporal lobe. Her blood cells are coagulating into small clots due to pregnancy, a condition called Thrombotic thrombocytopenic purpura (TTP).
Diagnosed Disease: Thrombotic Thrombocytopenic Purpura (TTP) - TTP is rare condition where platelets begin to clot together abnormally and in the process cause numerous blood-clots to occur and also damages normal blood cells because they bump into these large clots that form in the blood.
SymptomsAbsence seizures, bleeding, renal failure, fever, low platelet count, bruising, and anemia (low red blood cells since they are destroyed)
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CausesTo begin with, the von Williebrand Factor (VWF) is an essential protein that links platelets and blood clots to the blood vessel walls. However, when the protein is too long, it causes spontaneous coagulation of platelets. TTP has recently been classified as an auto-immune disease and a genetic disorder. In genetic TTP, the ADAMTS13 gene is mutated and thus causes a dysfunctional ADAMTS13 protein which is responsible for the proper breakdown of VWF. In the auto-immune version, anti-bodies have been shown to attack the ADAMTS13 protein, thus rendering it useless and causing the same symptoms.
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TestsA low platelet count and a low blood count are useful for diagnosis.
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Treatment/CurePlasmapheresis, a procedure where the patient's blood plasma containing the deficient clotting factors is replaced with donor plasma. This is repeated several times and can usually suffice as a cure; however, repeated cycles of this are needed throughout their lifetime.
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Blood smear showing damaged red blood-cells and a low platelet count. Black dots are coagulated platelets.
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Episode 20 - Love Hurts
Brief Plot Summary
House admits Harvey Park after realizing that he's suffering from a stroke. Moreover Harvey is shown to be a asphyxiaphyliac, meaning he likes to be strangled or smothered. Now, they believe its a trauma-induced aneurysm. Harvey then goes into a coma. House then realizes that Harvey has extremely bad breath, indicative of fulminating osteomylitis, infection of the jaw that wasn't seen because of the metal plate he has from reconstruction.
House admits Harvey Park after realizing that he's suffering from a stroke. Moreover Harvey is shown to be a asphyxiaphyliac, meaning he likes to be strangled or smothered. Now, they believe its a trauma-induced aneurysm. Harvey then goes into a coma. House then realizes that Harvey has extremely bad breath, indicative of fulminating osteomylitis, infection of the jaw that wasn't seen because of the metal plate he has from reconstruction.
Diagnosed Disease: Fulminating (Acute) Osteomylitis - Osteomylitis is an infection of the bone. When infected, the bone marrow swells and begins to press against the rigid outer wall of the bone where blood vessels are located. This cuts the blood supply to the bone, which dies. Dead bone is hard to cure since there is no way for immune cells to reach it without the blood vessels.
SymptomsStroke, coma, mood change, pus build-up in the area, fever, abscess
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CausesThe most common cases of osteomylitis occur in people with joint replacements, reconstruction surgeries, or from surgery to repair fractures or broken bones.
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TestsIt is somewhat difficult to test for osteomylitis. X-rays over several weeks can show changes that point to the disease, but CT and MRI scans are less effective. A biopsy is usually more accurate.
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Treatment/CureAntibiotics are used to treat the infection and generally take 4-8 weeks for the infection to clear. Surgery may also be required to remove any dead tissue.
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Source Links: University of Maryland, NIH Page
