House S08EP9 “Better Half”
Welcome SP12 BIO230 students! Every Monday evening, I like to unwind just a bit with the adventures of Dr. House, who believes with all his heart that the best treatment for seriously ill patients is humor. No wait, that was Patch Adams. Because the producers and writers of House pride themselves on their medical accuracy, I like to go through and review the science and recap the plausibility of each week’s medical mystery. So on Tuesday morning, you can find out whether I thought the episode was bogus or bonus or somewhere in between. This week on House, there isn’t much to go on from the episode summary at Fox.com:
The wife of an Alzheimer’s patient visits him at Princeton Plainsboro, and exposes deep marital strife that may be impacting his illness.
What could she be doing to her husband? Now back with a recap and SPOILERS!
The episode felt a bit slow, with the “A” plot of the Alzheimer’s patient working in a “B” plot of a married couple (patients of Wilson’s) who claim to be asexual. The “B” plot was just there for comic relief, so let’s ignore it for today. Our Alzheimer’s patient has early onset familial Alzheimer’s disease, a tragic and essentially untreatable neurodegenerative condition. But that’s not what’s wrong this week. Andreas was admitted to Princeton Plainsboro for violently coughing and vomiting blood during a routine neurological workup at the start of the show, and endoscopy shows a tear in the esophagus due to the violence of the coughing fit. The patient had no other recent symptoms other than a moderate sore throat a few weeks earlier that has resolved itself. The initial diagnosis is gall stones, due to slightly elevated liver enzymes, but this is quickly discounted. Blood in the urine then leads the team to suspect rhabdomyolosis, or a breakdown of muscle tissue leading to heightened levels of myoglobin in the blood that can result in serious kidney problems. A fever shortly begins to spike, which leads the team to then propose a disseminated viral infection that tied back into the observed sore throat from the initial patient history. He is put onto interferon therapy for treatment, which fails to make the patient better. Foreman has the final epiphany of realizing that the patient likely took aspirin for his sore throat earlier, and the since he has Alzheimer’s, kept on forgetting that he’d already taken some aspirin and so took some more. High levels of aspirin can result in Reye’s Syndrome, explaining all of Andreas’ symptoms, and treatable with steroid therapy.
Reye’s syndrome is an extremely rare (approximately 2 cases per year in the US) that has an association with aspirin use. These cases typically occur in children, mainly after viral infections such as chickenpox that are treated with aspirin to mitigate the virus symptoms. Once Reye’s Syndrome is diagnosed, based on a wide variety of signs and symptoms, supportive treatment such as steroid therapy can be given that can potentially allow the condition to resolve. Even with treatment, the prognosis of Reye’s Syndrome can be poor, and Wikipedia reports that approximately one third of the cases in the US during the past two decades have resulted in death.
There is a national association to promote awareness of Reye’s Syndrome in the US; it can be found at www.reyessyndrome.org. The website also indicates as noted by House that the condition is primarily a disease of children, and it further reiterates the connection with aspirin being used as a remedy for common childhood viral infections such as chickenpox. I would like to take the opportunity to point current BIO230 students to my calling to task of idiot parents from last semester who feel that it is a good idea to purposefully infect their children with diseases such as chickenpox. This is serious business, and death is a complication that can occur from a relatively innocuous condition like chickenpox. Parents must be aware of the fact however that even an innocuous condition can carry risks, and in the case of Reye’s Syndrome, these risks can be fatal.