House S08EP5 “The Confession”
After House’s apparent good fortune from curing someone with lots of money, he has apparently put himself into a position to hire back two thirds of his old team. It’s a good thing that they’ve been brought in for the consult, because they are stumped by Battlestar Galactica’s Lee Adama (Jamie Bamber), who collapses suddenly. He is apparently hiding some great secret that will of course facilitate his diagnosis. I am going to assume that his secret is not that he is secretly British, which is only associated with bad teeth, but something lending itself to a more insidious infectious disease. I’m predicting tertiary syphilis. Am I right? Updated Monday evening, with SPOILERS!
Well, I was off base with tertiary syphilis, although when I saw the key CAT scan Chase was holding up at the end, I thought maybe I picked up a diagnosis a week ahead. As an aside, I did enjoy the episode, mainly because they are getting back into the routine that works best; House works best when untethered, and the past two seasons saw the restrictions on ‘relationship’-House making him ‘ineffective’-House. The cast rearrangement this season works so far.
It is Chase that makes the final call this week, Kawasaki’s Disease, although my quick Wikipedia read indicates that this disease may have to fall in the BOGUS category unless the rationalization gets strengthened. Kawasaki’s Disease is an autoimmune disease, where a chronic inflammatory state causes multiple organ issues, very characteristic of the Type III immune hypersensitivities discussed in class. It is marked by signs and symptoms in many body sites, and we saw most of them this evening including: mysterious rashes, swollen lymph nodes, fever, pain, heart issues, liver dysfunction, and neurological deficits. It was the latter symptom that prompted Chase to run the CAT scan to find an aneurism leading to a personality shift that was fun to watch.
The treatment for Kawasaki’s Disease is intravenous injection of immunoglobulin, which feels almost paradoxical due to the immunologic basis of the disease. Wikipedia doesn’t explain how the treatment works, but I would think that a massive influx of non-specific immunoglobulin via IV injection will out compete the reactive self-antibodies from autoantigens, leading to temporary diminishment of the symptoms. Other treatments include anti-inflammatories such as aspirin and corticosteroids, although the astute House fan will note that corticosteroids were administered halfway through the episode unsuccessfully. The origin of Kawasaki’s Disease is unclear, but an infectious initiating agent is suspected. Very surprisingly, this case did not fit the standard profile for patients, who are typically Asian children. In Japan, the incidence is 1 in 450 children under the age of 5. Presumably, our patient tonight acquired it via an environmental source. This does feel like kind of a stretch to bring this disease into suburban New Jersey in a white adult male.
Next week on House: Scary Birthday Clowns! Stay tuned House Fans!