House S07EP12 “You Must Remember This”

Sam and Ilsa: "You must remember this, a kiss is just a kiss"

Awesome! A Casablanca-referencing title! From the Fox.com synopsis of the episode: the patient of the week has an interesting ability, which is perfect memory. Probably helped her out a lot as a college student! While suffering from a temporary paralytic event, a visit by her sister triggers complications. You know that there are some bad feelings between those two. The patient’s perfect recall proves to be an obstacle in her diagnosis and treatment, undoubtedly because she’ll be constantly contradicting House’s ideas in the process, which could prove to be fun. Master’s finds out that treating the patient is far easier that patching a broken sisterhood, and in an unrelated storyline, House is apparently giving Wilson dating advice and finds out who his “secret new companion” is.  Based on the way this season is going so far, I’m going to guess that it is Amber Volakis‘ (Cutthroat B###h) previously unintroduced twin. We’ll see how close wild speculation and snark get to the mark. Daughter #1’s guess is that Wilson has gotten a dog. With regards to the medical mystery and based on the apparent neurological symptoms (perfect memory and paralysis): my guess before watching the show is some sort of viral encephalopathy. Perhaps a herpesvirus, or maybe even an enterovirus! Click “read the rest” to see how I did!

OK!  Tuesday AM now, and how did we do? I’ll have to give bonus points to Daughter #1, for her very close guess about Wilson’s new secret companion. Apparently snark was uncalled for, and Wilson looks very happy with his new cat. I did enjoy House’s ragweed ploy to make Wilson think he was becoming allergic to the cat.

Let’s recap the differential diagnosis though. Nadia is a waitress who was initially admitted with a transient paralysis, and the team suspects early onset Parkinson’s. This is eliminated as she begins to show heart arrythmia as an additional symptom.  The arrythmia appears to be triggered with stress, which leads to further complications between Nadia and her sister alluded to in the summary above. A new symptom shows up: her breath smells like ammonia, which tells the team that her kidneys are shutting down, and raising the need for a kidney transplant. The best guess now is that the pathology is due to some autoimmune disease, and they begin to treat Nadia appropriately while looking for a donor.

Well, because this is TV, there can only one donor possibility, and that’s the sister that is now estranged. Note to all: be nice to your sister, because you never know when you might need a kidney!  They perform the transplant, however Nadia has seizures afterwards, indicating that the underlying cause is still unknown. Chase notices choreia, or involuntary movement, in Nadia’s hands. This is an important clue, and House picks up another one when he is in Nadia’s room and notices that she has Obsessive Compulsive Disorder (OCD.) House determines that these are all symptoms of McLeod Syndrome, a disease that affects the blood and kidneys, and gives her 20 years before she dies alone.

Well, I’d never heard of this syndrome, but as always Wikipedia is illuminating. Not a  lot of detail there, but it does give a concise summary. The upshot of McLeod Syndrome is that it is a genetic deficiency of the XK gene, which encodes a protein (Kell antigen) on red blood cells. The patient has abnormal erythrocytes, that progressively leads to systemic disorders and early death. McLeod Syndrome occurs in less than 1 in 100,000 people in the general population. At this point I have to add the “Bogus!” tag to the posting, as Wikipedia points out that the XK gene is found on the X chromosome, meaning that McLeod Syndrome is a sex-linked disorder. This means that most certainly Nadia and her sister’s father must have also demonstrated the syndrome (to give Nadia one bad copy of the recessive gene) and their mother must have been a carrier (to give her the other bad copy of the gene.) Now, I don’t recall at all any discussion of any family history beyond the two sisters, so this smacks of sloppy writing and a desire to trump drama over facts to me. Certainly a congenital genetic disorder would have very quickly led to a diagnosis.

We’ll see if next week can redeem this oversight and get back on track!

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About ycpmicro

My name is David Singleton, and I am an Associate Professor of Microbiology at York College of Pennsylvania. My main course is BIO230, a course taken by allied-health students at YCP. Views on this site are my own.

Posted on February 13, 2011, in Bogus!, House Party!. Bookmark the permalink. Comments Off on House S07EP12 “You Must Remember This”.

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