Season 3
Episode 9 - Finding Judas
Brief Plot Summary
Alice is a six year old who starts screaming uncontrollably on an amusement park ride. The team begins by finding pancreatitis and removes her gallbladder to check for stones to see if they are causing the condition. However, during tests, Alice's skin always seems to present an adverse reaction like an allergy, so since she can't be allergic to everything, House thinks infections and prescribes antibiotics. Alice worsens with liver failure and muscle rigidity. While running hemoperfusion, a clot gets stuck in Alice's arm and House believes it to be necrotizing fasciitis for which they must amputate. Last minute however, Chase has an epiphany and realizes she has erythropoietic protoporphyria.
Alice is a six year old who starts screaming uncontrollably on an amusement park ride. The team begins by finding pancreatitis and removes her gallbladder to check for stones to see if they are causing the condition. However, during tests, Alice's skin always seems to present an adverse reaction like an allergy, so since she can't be allergic to everything, House thinks infections and prescribes antibiotics. Alice worsens with liver failure and muscle rigidity. While running hemoperfusion, a clot gets stuck in Alice's arm and House believes it to be necrotizing fasciitis for which they must amputate. Last minute however, Chase has an epiphany and realizes she has erythropoietic protoporphyria.
Diagnosed Disease: Erythropoietic Protoporphyria (EP) - A type of porphyria in which the patient's skin is very sensitive to light which causes painful rashes and swelling. Porphyria's themselves are a class of genetic disorders in which the body does not make heme properly and lacks a particular protein necessary in the process. In EP, the lacking enzyme is ferrochelatase.
Symptomsskin rash, irritation, pain, burning, swelling, and redness all as a direct effect of intense light; painful photosensitivity; increased risk of gallstones; seen early in childhood
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CausesGenetic disorder in which the enzyme ferrochelatase is lacking
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TestsElevated porphyrin levels will be seen in the blood and genetic tests can be run to see if appropriate risk factors are present.
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Treatment/CurePatients usually need to be wearing sunscreen at all times. Basic sun protection will keep the disease at bay and Beta-Carotene has been proven effect in many cases.
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Source Links: NIH Porphyria, Porphyria Foundation
Episode 10 - Merry Little Christmas
Brief Plot Summary
Dr. Wilson and Detective Tritter give House a deal to spend 2 months in rehab instead of going to jail. House goes to Cuddy and meets a girl, Abigail and her mother who are considered to suffer from cartilate-hair hypoplasia, a type of dwarfism. Abigail has suffered from a collapsed lung without any apparent cause, which House believe is linked with her liver-failure. As they are running an MRI of her lungs she starts coughing up blood confirming House's prediction. Liver was clean for cirrhosis but showed sclerosing cholangitis. Foreman talks to House, who believes it to be a global systemic issue which will then hit the pancreas. She then presents with diabetic ketoacidosis a sign of pancreatic failure. Wilson suggests Hodgkin's lymphoma while Cameron believes Lupus. They once again go to a detoxing House for help who suggests Still's disease and tells them to start treatment. She then begins to bleed out of her nose and ears indicating a progressive systemic multi-system failure. House realizes she has normal growth-plates meaning that she is not producing growth hormones. She has a granuloma pressing against her pituitary gland; Langerhans cell histiocytosis.
Dr. Wilson and Detective Tritter give House a deal to spend 2 months in rehab instead of going to jail. House goes to Cuddy and meets a girl, Abigail and her mother who are considered to suffer from cartilate-hair hypoplasia, a type of dwarfism. Abigail has suffered from a collapsed lung without any apparent cause, which House believe is linked with her liver-failure. As they are running an MRI of her lungs she starts coughing up blood confirming House's prediction. Liver was clean for cirrhosis but showed sclerosing cholangitis. Foreman talks to House, who believes it to be a global systemic issue which will then hit the pancreas. She then presents with diabetic ketoacidosis a sign of pancreatic failure. Wilson suggests Hodgkin's lymphoma while Cameron believes Lupus. They once again go to a detoxing House for help who suggests Still's disease and tells them to start treatment. She then begins to bleed out of her nose and ears indicating a progressive systemic multi-system failure. House realizes she has normal growth-plates meaning that she is not producing growth hormones. She has a granuloma pressing against her pituitary gland; Langerhans cell histiocytosis.
Diagnosed Disease: Langerhans Cell Histiocytosis - A very rare disease combining auto-immune with cancer. It is usually multi-systemic and is characterized by auto-immune attack of abnormal/ aka cancerous Langerhan cells (dendritic cells in the skin and mucus) and other histiocyte cells (macrophages and dendritic cells) into the lymph nodes and other organ systems.
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To the left is a great video on the basics of immune system function. If you want to learn more about how the immune system works, I highly recommend KhanAcademy's videos on it; they are detailed and easy to understand. |
SymptomsCan vary depending on severity of the disease and its progression. Generally includes non-specific immune symptoms of infections (histiocytes are part of the non-specific immune system), legions and rashes on the skin, lymph node enlargement, liver enlargement, bleeding, organ failure
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CausesGenetic/mutagenic disorder affects about 1 in 200,000 people each year. Somatic mutations in the BRAF gene have been linked to the disease.
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TestsMost patients will present with granulomas which is just a collection of macrophages; aka, a tissue biopsy and histology will confirm
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Treatment/CureSteriods are used to suppress the immune system and any present granulomas that could be affecting the body are taken out. Radiation and chemotherapy can also be used depending on the stage and or a bone marrow transplant.
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Episode 11 - Words and Deeds
Brief Plot Summary
Derek is a fire fighter who escaped a burning building and he begins to have trouble breathing and becomes delirious. He begins to complain that he is freezing and is rushed to the hospital. The team first points at MRSA, but Derek begins to see blue. While testing for hormonal levels, Derek begins to choke Cameron. Foreman begins testing with a CT and lumbar puncture, but Derek has a heart attack in Amy's presence (Derek thinks she is engaged to his brother), broken heart syndrome. Derek has his memories removed via electroshock therapy, but it turns out his memories were fabricated. House deduces a spinal meningioma that had restricted blood supply to the brain and caused his symptoms.
Derek is a fire fighter who escaped a burning building and he begins to have trouble breathing and becomes delirious. He begins to complain that he is freezing and is rushed to the hospital. The team first points at MRSA, but Derek begins to see blue. While testing for hormonal levels, Derek begins to choke Cameron. Foreman begins testing with a CT and lumbar puncture, but Derek has a heart attack in Amy's presence (Derek thinks she is engaged to his brother), broken heart syndrome. Derek has his memories removed via electroshock therapy, but it turns out his memories were fabricated. House deduces a spinal meningioma that had restricted blood supply to the brain and caused his symptoms.
Diagnosed Disease: Spinal Meningioma - a spinal tumor originating from the meninges in the thoracic (80% cases), cervical (15% cases), lumbar (3% cases), foramen magnum (2% cases)
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To the left are two weighted MRI cross-sections of a spinal meningioma. The arrow points to the mass that is clearly compressing the thoracic region of the spinal cord. Depending on the level of compression this tumor can produce a variety of symptoms. |
SymptomsCan vary on the location and size of the tumor. However, for spinal meningiomas back and limb pain will be present due to the compression of the nerves in the spinal cord. In Derek's case, the mass also restricted blood flow to lead to a very eclectic set of symptoms. Nevertheless any sudden neurological or motor changes could point to a meningioma in a brain or spinal cord.
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CausesA meningioma is a type of cancer and thus causes are genetic susceptibility and random chance.
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TestsMRI's will usually reveal these growths whether in the spine or brain. However CAT or PET scans may be used.
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Treatment/CureSurgical removal of the growth will be required.
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Episode 12 - One Day, One Room
Brief Plot Summary
While House is on clinic duty, he comes across a woman name Eve who has been raped and has chlamydia. She is advised to consult with a psychiatrist but she insists on being treated by Dr. House. When House doesn't want to treat her, she swallows a bottle of sedatives to get his attention. The rest of the episode is a back and forth between House and Eve.
While House is on clinic duty, he comes across a woman name Eve who has been raped and has chlamydia. She is advised to consult with a psychiatrist but she insists on being treated by Dr. House. When House doesn't want to treat her, she swallows a bottle of sedatives to get his attention. The rest of the episode is a back and forth between House and Eve.