Season 2
Episode 17 - All In
Brief Plot Summary
Ian is a 6 year old who suddenly started bleeding out of his colon. Cuddy thinks it is gastroenteritis; however, House thinks otherwise. Ian can't grab House's cane which indicates that his brain is losing control of his muscles. House considers Erdhein Chester Disease, then lymphoma, but both are proven wrong. They now spot a mass in the pituitary, and based on a previous case, House thinks it will hit the liver next. He orders a variety of meds to protect the liver. Ian's platelets drop and then he goes into respiratory distress and is put on a ventilator. After noticing a mass in the right atrial valve, House orders a biopsy. He tests for histiocytosis and tubular sclerosis, both appear negative but are still plausible. Then he realizes that his first diagnosis was right but the disease hadn't progressed far enough.
Ian is a 6 year old who suddenly started bleeding out of his colon. Cuddy thinks it is gastroenteritis; however, House thinks otherwise. Ian can't grab House's cane which indicates that his brain is losing control of his muscles. House considers Erdhein Chester Disease, then lymphoma, but both are proven wrong. They now spot a mass in the pituitary, and based on a previous case, House thinks it will hit the liver next. He orders a variety of meds to protect the liver. Ian's platelets drop and then he goes into respiratory distress and is put on a ventilator. After noticing a mass in the right atrial valve, House orders a biopsy. He tests for histiocytosis and tubular sclerosis, both appear negative but are still plausible. Then he realizes that his first diagnosis was right but the disease hadn't progressed far enough.
Diagnosed Disease: Erdheim Chester Disease - This is an extremely rare condition for which there are a very limited number of known cases. It is characterized by excessive production of histiocytes such as macrophages, which then accumulate in loose connective tissue.
SymptomsSymptoms start with colon problems and diarhea, then coordination problems, then pituitary gland problems, followed by liver and/or kidney failure, and finally respiratory distress. Other symptoms can include bumps under the skins from lipid deposits (xanthomas), vision problems, bone pain, and heart issues.
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CausesThere is no know cause as to why the disease manifests but the symptoms occur because histiocytes, such as macrophages, accumulate in connective tissues, which causes them to thicken and become fibrotic. Thus it is a systemic disease that can occur a variety of different organ systems.
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TestsThere is no definative test to confirm due to the rareness of the disease and the difficulty in differentiating it from langerhans cell histiocytosis (LCH). However, osteosclerosis and tissue histology to test for macrophages in the tissue can be used to set it apart.
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Treatment/CureThere is also no proven treatment; however, interferon, corticosteroids, vinca alkaloids and anthracyclines have all been used.
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Episode 18 - Sleeping Dogs Lie
Brief Plot Summary
Hannah hasn't slept for 10 days and still can't sleep even after consuming an entire bottle of sleeping pills. Oddly enough, it seems that she is stil able to sleep, but for no more than a minute at a time. A rectal bleed could indicate colon cancer. They find nothing in the colonoscopy and now House thinks it's Wegener's Granulomatosis. However, Hannah's liver fails, but they are able to transplant her girlfriend's liver and buy some time. When House realizes that they bought he dog, he lifts Hannah's arm and finds a large fluid-filled bubble. He draws thick black ooze and reports a case of the plague.
Hannah hasn't slept for 10 days and still can't sleep even after consuming an entire bottle of sleeping pills. Oddly enough, it seems that she is stil able to sleep, but for no more than a minute at a time. A rectal bleed could indicate colon cancer. They find nothing in the colonoscopy and now House thinks it's Wegener's Granulomatosis. However, Hannah's liver fails, but they are able to transplant her girlfriend's liver and buy some time. When House realizes that they bought he dog, he lifts Hannah's arm and finds a large fluid-filled bubble. He draws thick black ooze and reports a case of the plague.
Diagnosed Disease: Bubonic Plague - The plague is a now rare bacterial infection that is thought to have wiped out much of Europe's population during the Middle Ages. It is a deadly infection of the lymphatic system, lungs, or blood that first presents with flu-like symptoms and then begins to attack systemically. In the episode, Hannah is sick with Bubonic Plague, meaning the lymphatic version.
SymptomsChills, fever, headache, muscle pain, in rare cases other neurological symptoms (inability to sleep as seen in the episode), seizures, painful lymph node swelling called a bubo containing thick black fluid.
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CausesThe plague is caused by a bacteria called Yersinia pestis that is transferred to humans by rat flea and in rare cases dog flea bites or through contaminated water.
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TestsTesting the fluid in the bubos is an easy confirmations; however, for the other two types, a blood test can be used to diagnose the condition.
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Treatment/CureAn immediate course of antibiotics is needed. Theses include streptomycin, gentamicin, doxycycline, and fluoroquinolone ciprofloxacin.
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Source Links: NIH Page, WHO International
Episode 19 - House vs. God
Brief Plot Summary
A 15-year old Boyd Mullins is a preacher who suddenly collapses to the ground, clutching his stomach. Dilute urine and low sodium could indicate kidney dysfunction. Tests show that it's not Addison's. House notices him drinking too much water which could cause his symptoms. An MRI shows a small abnormal area that House asserts is tuberous sclerosis, which causes small benign tumors to grow throughout the body. However, Boyd gets a fever which can't be caused by tuberous sclerosis. House and Wilson realize that he has herpes encephalitis.
A 15-year old Boyd Mullins is a preacher who suddenly collapses to the ground, clutching his stomach. Dilute urine and low sodium could indicate kidney dysfunction. Tests show that it's not Addison's. House notices him drinking too much water which could cause his symptoms. An MRI shows a small abnormal area that House asserts is tuberous sclerosis, which causes small benign tumors to grow throughout the body. However, Boyd gets a fever which can't be caused by tuberous sclerosis. House and Wilson realize that he has herpes encephalitis.
Diagnosed Disease: Herpes Encephalitis - Herpes Encephalitis is encephalitis (acute inflammation of the brain) that is brought on by infection of the herpes simplex virus.
SymptomsMost symptoms are neurological and include hallucinations, mood changes, seizures, confusion, and fever.
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CausesHerpes can be "inherited" from the mother or it can be contracted through sexual interaction or any exchange of fluids in the body. In the episode, Boyd gave a terminal cancer patient the infection by scratching his rash and touching her.
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TestsDiagnosis requires testing of the spinal fluid with a lumbar puncture; however, it is recommended to start treatment before the test results arrive.
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Treatment/CureAciclovir, a popular antiviral drug is the immediate course of treatment for infection by the herpes virus.
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Source Links: Medscape Reference
Episode 20 & 21 - Euphoria (part 1) & Euphoria (part 2)
Brief Plot Summary
A cop named Joe Luria is shot by a gang member while giddily mocking. Luria is in a state of euphoria, but the bullets are lodged in the wrong place to cause it. They think carbon monoxide poisoning and put him in a hyperbaric oxygen chamber. Foreman searches Joe's filthy apartment for clues and finds a marajuana farm. House thinks it could be Legionnaire's disease. However, another symptom shows when they realize that Joe can physically see, but his brain cannot process the information (Anton's Blindness). Joe begins to suffer from tachycardia (increased heart rate). Suddenly, they realize that Foreman displays signs of giddyness that Joe had and House puts him in an air-tight room with Joe. Now Joe is aware of his blindness, claiming that he can't see anything. Joe is now in severe pain and when he doesn't respond to morphine, they realize that he has another symptom, hyperalgesia, meaning the infection has reached the pain center telling it that the body is in tremendous pain. No meds can stop the pain now. Cameron and House come back with a sample of pigin droppings that House believes contain Cryptococcus neoformans, which would explain the symptoms. However, he is wrong. Joe dies after sudden cardiac arrest. Foreman now has Anton's Blindness and its progressing faster in his body. House realizes that Joe had Legionnaire's and didn't get worse until they treated it; he infects Foreman with legionella. House now thinks that the disease might be something the body can't fight, meaning no antibodies and negative results on the tests. He gives Foreman antibiotics for Listeria. However, his condition worsens and Foreman wants a white matter brain biopsy which could paralyze him forever. House goes back to Joe's apartment and finds that the water is infested with Naegleria. Foreman has amoebic meningoencephalitis.
A cop named Joe Luria is shot by a gang member while giddily mocking. Luria is in a state of euphoria, but the bullets are lodged in the wrong place to cause it. They think carbon monoxide poisoning and put him in a hyperbaric oxygen chamber. Foreman searches Joe's filthy apartment for clues and finds a marajuana farm. House thinks it could be Legionnaire's disease. However, another symptom shows when they realize that Joe can physically see, but his brain cannot process the information (Anton's Blindness). Joe begins to suffer from tachycardia (increased heart rate). Suddenly, they realize that Foreman displays signs of giddyness that Joe had and House puts him in an air-tight room with Joe. Now Joe is aware of his blindness, claiming that he can't see anything. Joe is now in severe pain and when he doesn't respond to morphine, they realize that he has another symptom, hyperalgesia, meaning the infection has reached the pain center telling it that the body is in tremendous pain. No meds can stop the pain now. Cameron and House come back with a sample of pigin droppings that House believes contain Cryptococcus neoformans, which would explain the symptoms. However, he is wrong. Joe dies after sudden cardiac arrest. Foreman now has Anton's Blindness and its progressing faster in his body. House realizes that Joe had Legionnaire's and didn't get worse until they treated it; he infects Foreman with legionella. House now thinks that the disease might be something the body can't fight, meaning no antibodies and negative results on the tests. He gives Foreman antibiotics for Listeria. However, his condition worsens and Foreman wants a white matter brain biopsy which could paralyze him forever. House goes back to Joe's apartment and finds that the water is infested with Naegleria. Foreman has amoebic meningoencephalitis.
Diagnosed Disease: Amoebic Meningoencephalitis - Caused by a fresh water amoeba, this deadly disease is characterized by a rapid consumption of neurons and brain matter as the amoebas quickly multiply and spread throughout the brain.
SymptomsIt usually starts with a change in the smell since they usually manifest first in the olfactory bulbs, but sometimes they can infect elsewhere, such as via the optic nerve as in the episode. Symptoms can be extremely varied but usually progress at a rapid rate and affect only neurological aspects before reaching the brain stem at which point they cause death.
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CausesThis is a disease caused by an infection of Naegleria fowleri, an amoeba that lives in freshwater. Infection begins in the nose and the organisms quickly travel to the brain via the olfactory nerve. Incredibly, the body is unable to sense their presence which is why legionella, a recognized bacteria, caused improvement. The amoebas simply got caught in the crossfire. In the brain, they multiply and rapidly consume brain cells and spread throughout the brain causing a variety of symptoms and eventually death when they hit the brainstem.
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TestsA deep, white matter brain biopsy will definitely reveal the amoeba; however, it is an extremely dangerous procedure. A sample of water under the microscope can also reveal the organism.
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Treatment/CureThe treatment is Amphotericin B which is the best know systemic anti-fungal that is capable of fighting parasitic protozoans. However, the drug is also a nephrotoxin and is highly likely to damage the kidneys during treatment, a necessary risk.
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