House S08EP7 “Dead and Buried”
As we come up with the last couple of episodes of House on the Fall 2011 semester, our patient of the week is apparently suffering from something more significant than teen spirit. House is very concerned with a patient who is no longer alive, so presumably that patient isn’t going to recover. But since a dead person cannot talk back, it’s just the sort of patient House likes. Chase also becomes infatuated with matters relating to grooming, which annoys Dr. Park. I’m guessing that it’s because he’s got a new honey on the side, and I’m guessing that it’s Dr. Adams. Am I right? Now back after the break, with a recap and SPOILERS!
All in all, a bit of a confusing episode, but there is some interesting character development. The episode follows two intertwined cases: Iris, a 14 year old girl who has been admitted with a severe anaphylactic shock episode brought on by an IgE-mediated allergy to strawberries, and Drew, a 4 year old boy who died unexpectedly 5 years previously. House is obsessed with the second case, leaving the team to work on saving Iris’ life. With Iris, a litany of signs and symptoms progress, including a positive pregnancy test, tunnel vision, and hypertension, with a bout of multiple personalities to top it all off. The team believes that the symptoms are being masked to some degree by the different personalities, and so to try and figure out if there is a root cause to Iris’ problems they put her under hypnosis. It is under hypnosis and regression to an early childhood trauma that a final sign emerges; vaginal bleeding, which leads House to the correct diagnosis of choriocarcinoma, or cancer of the uterus. No mention is made for a prognosis, however Wikipedia indicates that choriocarcinoma is extremely sensitive to chemotherapy with a cure rate in the 90 to 95% range.
I found Drew’s case actually a bit more compelling, possibly because House did as well. Drew had died of kidney failure, but had a number of other signs including airway malformations and partial deafness. House only figures out this last clue after talking to Drew’s grandfather and realizing that he too was partially deaf, suggesting a genetic abnormality in the family. The diagnosis is Alport’s Syndrome, a disease characterized by mutations in one of the several genes for collagen, a critical component of connective tissues. Many of the mutations are X-linked, and therefore manifestation of the disease in women is typically significantly less severe than in men, who only have one copy of the X-chromosome. This was the case in the episode tonight where Drew’s grandfather (showed the syndrome) passed on a defective gene to Drew’s mother (was asymptomatic, but carried a bad gene), who passed it on to Drew (showed the syndrome). Clinical manifestations of Alport Syndrome are defects in basement membranes of the kidney, inner ear, and the eye. Treatments when the disease is recognized focus on managing and preventing kidney failure; there is no cure at present, although gene therapy approaches have been discussed. Interestingly, Wikipedia points out a potential problem with managing Alport Syndrome with a kidney transplant following kidney failure. The presence of wild-type collagen on the donor kidney represents a profound foreign antigen for the Alport Syndrome immune system, and consequently a significant antigenic target for organ rejection responses in the transplant recipient.
All in all, I found this episode a bit disturbing; the two back to back episodes with kid patients is getting to me perhaps too much. I did like Wilson’s observation about House’s personality though, that his addictive personality is not limited to narcotics. Says Wilson:
I’m an idiot for thinking that your addictions were limited to pills, anti-social behavior, and sarcasm. You’re also addicted to puzzles. You show all the classic behaviors. Lying, neglecting responsibilities, and you can’t stop, no matter devastating the consequences.
I suppose in the end I am too, and that’s why I watch. Next week: a prosecutor suffers an apparent MI while cross-examining a witness in court. And I though Micro lecture was a high stress job!