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Case History Edit
After performing his duties at the mission, Father Daniel heard knocking at the door and, when he opened it, he saw a floating and injured Jesus Christ in front of him. He went to the Princeton-Plainsboro Teaching Hospital emergency room. Dr. Cameron saw him and figured he was just drunk and had a hallucination. However, Dr. House asked that the case be assigned to him, but Dr. Cameron said it had to be alcohol or exhaustion, but she agreed to let him take the case.
When Dr. House brought the case to his team and suggeseted psycho-motor epilepsy but Dr. Taub also thought it was alcohol. Dr. House also suggested atropine toxicity and occipital lobe tumor. He ordered an EEG and CT Scan. He also ordered an environmental scan.
Father Daniel said he wasn't drunk, although he had been drinking. He had a history of moving around. He admitted that a 14 year old had accused him of inappropriate contact, but he denied anything had happened. Dr. Taub said it might be relevant because syphillis could explain the symptoms. Father Daniel said he had never been sexually active and entered the seminary at 17.
Dr. Taub wanted to discharge the patient and Dr. House agreed they had ruled out all the possibilities but alcohol.
The patient didn't want to be discharged and claimed it wasn't just the alcohol. He felt nauseous and his left foot felt like it had fallen asleep. Dr. Kutner wondered why he hadn't mentioned it before, and he said he just noticed it. Dr. Kutner examiend the foot and found that one of his toes had fallen off.
The necrosis and hallucinations pointed to leprosy or ergot poisoning. However, the symptoms didn't fit well with leprosy and his white blood cell count was normal. He then suggested carbon monoxide poisoning. He ordered that the environmental scan be completed, that they contact Dr. Hadley to test for carbon monoxide in the patient's blood and to put the patient in a hyperbaric chamber.
Dr. Taub and Dr. Kutner searched the mission. The heater had no carbon monoxide leak. Dr. Taub found the patient's cigarettes, but Dr. Kutner noted that smoking in a well ventilated area like his room wouln't result in carbon monoxide poisoning.
Father Daniel's necrosis did not appear to be spreading. However, he started panicking when in the chamber. They released him and he said he couldn't breathe. Dr. Kutner believed he was having a heart attack.
However the chest pain wasn't angina and an EKG ruled out the possibility of a heart attack. Dr. House thought it might be a clotting disorder, but this would mean each symptom was the result of a different clot. He ordered an angiogram and went to see the patient.
He asked the patient if was really a virgin as if he was lying, it would be harder to diagnose him. The patient repeated he was telling him the truth. However, Dr. House still didn't believe him. Dr. Taub reported there was nothing wrong with Father Daniel's lungs - no pneumonia, pleurisy or embolism. Dr. Kutner warned the patient the procedure would hurt, but the patient said he didn't feel any pain from what he was doing. Dr. House pinched him near the neck, and the patient said that didn't hurt either. This meant he had regional anesthesia - a new symptom. Dr. House realized the heart pain and foot numbness might be related and ordered a nerve conduction study.
They did a full opthamology exam and found nothing structurally wrong with the eye. However, his heart rate was falling and his sensory problems were becoming more diffuse and he was suffering from increasing muscle weakness. Dr. Hadley suggested it could be something systemic like an autoimmune disease. However, they had checked his cerebro-spinal fluid and it was negative for Guillain-Barre syndrome. She suggested cancer, but the patient's imaging studies were all clear. She suggested infection, but the patient's white blood cell count remained normal. However, Dr. House suggested that the patient may not be producing white blood cells and ordered a biopsy of his spleen.
Dr. Kutner performed the biopsy. However, it showed only insignificant traces of common bacteria and viruses - nothing that would make him ill. However, Dr. Taub realized the minor infections could point to something else. He had pneumocystis, which is common and harmless unless you have a compromised immune system. They realized that Father Daniel had AIDS.
When they informed Father Daniel, he said it was impossible. He denied ever having a transfusion, using intravenous drugs or having sex. He refused to have an AIDS test because if were a false positive, he would lose all credibility with his treating physicians. When Dr. Taub suggested he had no credibility, Father Daniel shot back that Dr. Taub never believed him from the beginning.
Dr. Taub wanted to start anti-retrovirals, but Dr. Kutner insisted on confirming because the side effects were severe for a patient without the disease. Dr. Taub also wanted to find the boy that Father Daniel molested so he could be tested. Dr. Kutner pointed out that they couldn't inform a sexual partner about an STD without confirming it first. Dr. House told them to treat Father Daniel for AIDS but to forget about informing the teenager.
However, Dr. Taub insisted on hunting down the teenager and told him that Father Daniel had AIDS. The teenager didn't think it was relevant, but Dr. Taub told him he should get tested. The teenager asked if Father Daniel was very sick, and Dr. Taub confirmed he was. However, the teenager just thanked him and sent him away saying he had already been tested and it wasn't Dr. Taub's business what the result was.
Father Daniel insisted he didn't have AIDS, but Dr. Kutner said he had two choices - agree to the test or stop lying. Suddenly, Father Daniel's blood pressure started to climb and he said he felt flushed. He then found a number of skin lesions on his chest.
Dr. Taub felt the rashes were a reaction to the medication, but Dr. Kutner felt they were an indication that it wasn't AIDS. Dr. House suggested Hyper IgE syndrome. However, Dr. Kutner had thought of that, and tested the IGE levels, which are normal. He thought it was another genetic disease. Dr. Hadley thought it was cerebral microtumors. However, Dr. Foreman pointed out the genetic tests would take too long and treatment was surgery. Dr. House ordered genetic testing.
Dr. Taub still thought it was AIDS and told the patient they were considering other conditions. All of a sudden, the teenager appeared in the room and insisted on speaking to Father Daniel. To Dr. Taub's surprise, the teenager was there to apologize to Father Daniel and ask forgiveness. Father Daniel told him he knew how sorry he was.
However, Dr. House suddenly thought of something else. He started eliminating symptoms one by one and when he eliminated the hallucination, the symptoms fit Wiskott-Aldrich Syndrome. He went to the patient to tell him he wasn't going to die. Wiskott-Aldrich also suppressed the immune system, mimicking AIDS. It's a genetic condition that he was born with. He planned genetic tests to confirm because the hallucinations were probably just a coincidence caused by his drinking. However, Father Daniel realized that thanks to Dr. House taking his case, his entire life had turned around in just one day.
The genetic testing confirmed Wiskott-Aldrich. Dr. Cameron was somewhat dismayed that she wanted to discharge him, but Dr. Cuddy assured her that any other doctor except Dr. House would have done the same thing.