House S08EP14 “Love Is Blind”
It’s been a few weeks of reruns on the Fox Monday night schedule, and a little bit of a break after this one as the season finale of Alcatraz preempts the final couple of episodes of House. From the Fox.com House site:
House and the team battle to save a successful, independent blind man (guest star Michael B. Jordan) who is struck down by a mysterious illness, just prior to him asking for his girlfriend’s hand in marriage. Meanwhile, House’s mother (guest star Diane Baker) unexpectedly arrives at Princeton Plainsboro to inform him of her new beau (guest star Billy Connolly)
Here’s hoping to an infectious disease, as it feels like it has been a while with a good bacterial etiologic agent. What will we have? Well, here are some SPOILERS; it was a fungal infection! Go, fungus!
What would be even better than a bacterial infection? A fungal infection!
The key to what led to the final diagnosis this week was the patient’s diabetes. Diabetics are particularly prone to developing a number of opportunistic infections that the general population is resistant to. Our patient this week was diagnoses with mucormycosis, a deep seated tissue infection that can be caused by a variety of common soil fungi, including members of the fungal family that common bread molds belong to. The reason that diabetics are susceptible to fungal infections is unclear, but likely is related to their altered glucose metabolism.
The patient inhaled spores from this fungus, and developed a focal pneumonia infection that House finally spotted on an imaging film at the end, that had initially been characterized as a clot in the differential diagnosis. The patient’s other symptoms at that point had included a number of bacterial and viral agents that might lead to the aggressive tissue necrosis that was happening at the end of the episode. Viruses were eliminated, due to the lack of a high fever, and bacteria were eliminated from the broad spectrum antibiotics that had been previously eliminated. Park confirmed the diagnosis of a fungal infection by microscopy. The standard for treating an aggressive fungal disease is an antibiotic that BIO230 students know well, Amphotericin B.
Adams was immediately concerned with this treatment for the fungal infection, because it would very likely lead to the final twist of the episode. Although amphotericin B is the gold standard for treating systemic fungal infection, it does have a high level of toxic side effects on its own. In this case, the side effects of amphotericin B can be exacerbated by another compound which was gentamycin, a broad spectrum bacterial antibiotic that had been given to the patient in high doses when an unknown bacterial infection was still on the table. The complication with this patient is almost certain deafness, due to the combination of amphotericin B and gentamycin. Since he is already blind, he wants to refuse the treatment that would save his life.
So there are a couple of things that I really liked medically in this episode, in addition to seeing the ever entertaining Billy Connolly. First, patients may be immunocompromised for a wide variety of reasons, and therefore extremely susceptible to common infections completely exclusive of HIV infection. Obtaining a firm patient history and understanding the ramifications of preexisting conditions is critical in determining risk assessment. Second, although I really stressed in class the dangers of overuse of antibiotics and our risk of developing microbial resistance, the current use of antibiotics can lead to other dangers particularly when used in combination as occurred in this episode.