House S08EP6 “Parents”
“On the next episode of House” via the fox.com House site, we will be treated to drama AND mystery, and hopefully more hijinks! A teenager with show-biz aspirations becomes paralyzed and needs a bone marrow transplant, and a disturbing family secret is revealed. Obvious plot development–some family member actually is not related to someone else, and I don’t need to be a television writer to see that one coming. So there’s our drama and mystery, and the hijinks will be by House’s continued efforts to remove his ankle bracelet. Hopefully he won’t use the approach he used last season in this episode. Taub’s idyllic family life takes a turn for the worse, when his ex-wife says she is moving across the country. Will the team figure out what’s wrong with the patient? Updated Tuesday morning with a diagnosis recap and SPOILERS!
Well, I have to admit I squirmed just a bit with the big episode reveal, and I imagine that the Fox executives must have as well, particularly with the ongoing news saga from Penn State University in the limelight. The final patient diagnosis was syphilis, which had been dormant in the patient (a teenager) for the better part of a decade. Syphilis is caused by a spirochete bacterium, Treponema pallidum, and is only acquired sexually and in this case it had been acquired from another family member and the memory of the encounter had been repressed.
The pathology of syphilis is actually very interesting, and cases progress through a series of characteristic stages. In primary syphilis, the spirochete enters the body through abrasions in the skin, and within a few days to weeks post infection a small painless lesion may form at the site of infection. The immune system at this point begins to mount a response that can bring the initial infection under control, but not eliminate it. Secondary syphilis can several weeks after the primary infection, and instead of being localized at the initial site of infection, the pathology is more systemic with a number of organ and body systems possibly impacted. Primary and secondary syphilis are both responsive to antibiotic treatments, however the patient can go into remission spontaneously without treatment in a stage known as latent syphilis, which can actually last for an extended period of time.
Some patients can enter into tertiary syphilis, a late stage form of the disease that can occur anywhere from 3 to 15 years after the initial infection. Tertiary syphilis is caused by the bacterium, but actually represents a hyperimmune response to the pathogen, such that most of the signs and symptoms are attributable to the body’s response to the bacterium as opposed to the bacterium itself. Tertiary syphilis is marked by large inflammatory lesions in many body sites, inflammation of the central nervous system leading to cognitive defects, and vasculitis which can lead to aneruism. In tertiary syphilis, the use of antibiotics is less useful than treatment with anti-inflammatories or immunosuppressants to reduce the signs and symptoms of the disease.
The patient in this episode presumably was in the latent stage, which was exacerbated into an active infection by the blunt force trauma at the start of the episode. Several treatments were administered during the course of the episode, including antibiotic use and immunosuppressants, none of which eliminated the disease. This was likely secondary syphilis, even though I think the timing was off for that form of the disease, so the immunosuppressants were ineffective in treatment. The antibiotics were the recommended treatment, however the patient had a complication in the form of a severe Jarisch-Herxheimer reaction, which occurs when a large number of bacteria are killed off by antibiotics releasing endotoxins into the bloodstream. The endotoxins then lead to a persistence of symptoms after the antibiotic treatment is finished.