House S07EP14 “Recession Proof”
It may be Winter Break at YCP, but that doesn’t mean we are all on vacation; I’ll still watch House, and check to see if the episode is “bonus” or “bogus.” My weekly checkup at Fox.com indicates that perhaps this week may focus a bit more on medicine than last week. The capsule summary tells us that a blue-collar worker is hiding a secret from his spouse, when he shows up in the hospital with a severe rash after being exposed to a caustic chemical at work. In the “B” plot, Dr. Cuddy is to receive an award, and wants House to be there as well, but the case prevents his full participation. We are also treated to a “C” plot, where Chase and Masters bond and learn something about relationships. I wouldn’t get too attached to Dr. Masters though, because according to TV Squad, Dr. Thirteen will be returning in a few episodes. Hopefully all plots will resolve within 59 minutes, and we’ll learn what is making our working man sick. Since this is TV, I’m going to assume that the chemical spill is a red herring, or the precipitant of some underlying issue with the patient.
Well, we’re back. The patient dies at the end, and House decides that the loss of this patient, along with the couple of other ones this season, are a reflection of his ineffectiveness as a doctor. He’s left with a choice at the end: being a good doctor, or continuing his relationship with Cuddy. Looks like it might be time to hit the reset button!
Let’s review the symptoms through the episode. The patient initially presented with a rash and apparent anaphylactic shock, presumably due to exposure to environmental triggers. As the symptoms develop, he also spikes a fever several times, and has some hallucinatory episodes. The team suspects now an unknown bacterial or fungal infection, and put him on broad spectrum antibiotics in an attempt to clear up the symptoms. This recourse fails, and then the team considers a tumor, and orders an MRI to confirm. While getting ready to perform the imaging, the patient complains about the cold temperature in the MRI room, and has a seizure. One final symptom shows up: the rash returns, and this is House’s epiphany moment. He determines that the patient is suffering from familial cold autoinflammatory syndrome.
This is one of a family of cryopyrin-associated periodic syndromes (CAPS,) a group of syndromes due to a mutation in the CIAS1/NALP3 gene. House’s recommended treatment is anakinra, an anti-inflammatory drug used to treat rheumatoid arthritis. The disease is genetically determined, and the incidence of the disease in the US is extremely low, with only a few dozen cases that have been reported to the National Institutes of Health at present. The disease has profound effects on the lives of patients, with the patients adjusting their behavior to cope with minimizing flareups associated with the disease. It is likely that the backstory associated with this episode (the patient losing his high pressure/high visibility job and taking a series of menial, antisocial jobs) was a symptom as well.
My final verdict: well, this is the second infrequent genetic disease in a row. At least this one is obscure enough that my complaint from two weeks ago is less valid. Still, it’s a valid diagnosis, but I’d like to get back next week with a good old infectious disease.