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Case History Edit
The patient was admitted at the emergency room with acute respiratory failure. She had no anaphalaxis, lung issues or tracheal lesions. Her tox screen was clear for cocaine and amphetamines. Dr. House believed that the patient's obesity caused sleep apnea which inflammed her epiglottis and caused the symptoms. However, the patient had reported no difficulty with sleeping. Dr. House then believed whatever was causing her husband's lung problems was also affecting her. However, the husband was suffering from lung cancer, which is not contagious. Her only history of travel was to Hawaii about six months previously. Dr. Foreman believed it might be melioidosis. However, if this was the case, the husband would have it too. There was no sign of tumor, drugs or bacteria in her system. The most likely diagnosis was a virus. Dr. House wanted to order intravenous fluids and acyclovir, but the patient was demanding to be released so she could be with her dying husband. However, Dr. Taub had arranged for the husband to be admitted as well. The patient improved rapidly with treatment and she was prepared for discharge.
However, the patient was soon suffering from severe chest pain. The nurses checked her airway, which was clear. Her pulse was rapid but regular.
The patient's cardiac enzymes were normal, which ruled out a heart attack. Her vision was normal, which ruled out a mitochondrial disease. Dr. Foreman suggested that it might be a metabolic disorder. However, acidosis was ruled out as her blood pH was normal. Dr. Hadley suggested that polyserositis would inflame the epiglotus and the pericardium, which would explain the breathing and chest pain. Dr. House agreed and ordered indomethacin. Dr. Taub went to treat the patient. However, the treatment was not effective, ruling out the diagnosis. Dr. Taub ruled out Wegener's disease. Her kidney function was normal which ruled out byssinosis and mitral valve stenosis. Dr. House believed there was only one remaining possible diagnosis. He told the patient she must have hypertrophic cardiomyopaty, a heart muscle that was too strong. He sought consent to give the patient a heart attack to kill off some of the muscle. When she objected, Dr. House accused her of faking the symptoms she had just before she was about to be released. He believed that since her husband improved when she got sick, she got sick in an attempt to improve his condition. The patient admitted the deception, but then cried out in pain and complained of leg pain. However, when Dr. House examined her leg, he found that it had atrophied. He realized that there was no way to fake that symptom.
Dr. Taub suggested the muscle atrophy could be the result of multiple sclerosis. Dr. House ordered an MRI to confirm. However, when Dr. Hadley performed the MRI, the patient went into distress as a result of a ruptured spleen. Dr. Chase operated and noted that the ruptured spleen ruled out MS. He also agreed to perform a biopsy to attempt to confirm rheumatoid arthritis. However, Dr. Chase soon ruled out rheumatoid arthritis as the patient had liver scarring. This indicated whatever disease she had was spreading.
Given the liver was only operating at 20%, Dr. Hadley suggested autoimmune hepatitis. However, the patient's thyroid function was normal. Dr. Taub suggested amyloidosis, but this would not explain the muscle atrophy. Dr. House believed it might be alpha-1 antitrypsin deficiency. He ordered a test on her AET proteins.
However, while the test results were being processed, the patient broke into a medicine cart and injected herself and went into a seizure as a result. Dr. Hadley believed she was doing it to make herself worse to make her husband better, but Dr. Taub believed it was a suicide attempt so that she could donate her heart to her dying husband. The patient was stabilized but the injection totally disabled all liver function. The patient had about 24 hours before she needed a new liver. The AET protein test was normal. Dr. Hadley believed it might be myelofibrosis, but this would take 48 hours to confirm. A liver transplant was her only option, but she could not get one unless her underlying condition was diagnosed. Dr. House planned to get the husband to agree to a partial transplant. However, he would not survive the procedure which meant that his entire liver would be available for donation. He enlisted Dr. Cameron to get the husband's consent. He agreed to the procedure, but Dr. Cameron believed that the husband had been misdiagnosed. She convinced Dr. House to run more tests, and he did find that he was suffering from cardiac blastomycosis, a fungal infection, and not lung cancer. He was treatable. However, he still wanted to go ahead with the liver transplant.
Dr. Taub told Charlotte that Eddie was treatable and she did not want him to go through with the transplant. However, she once again became distressed. This time, she had a fever and a lumbar puncture showed an extremely high white blood cell count. Dr. Hadley believed it might be sarcoidosis, but this would not explain the lung issues. Dr. Taub suggested scleraderma, but the patient had no skin or digestive tract problems. However, Dr. House recalled she always wanted to go to Rio de Janeiro. He asked her to admit she went there and not to Hawaii as visceral leishmaniasis would explain all her symptoms. She admitted that she went there with another man. Dr. House ordered antimony and directed Dr. Taub to approach Dr. Cuddy to obtain a liver transplant. A liver was found for the patient, but she did not improve with treatment as a result of the late diagnosis. She eventually died from a cardiac arrest.