Medical History Edit
As an adult film star, Hank has had numerous sexual partners and realizes he is at risk for STDs. He is tested every three months and has been treated for such diseases in the past.
Case History Edit
Upon admission, he was given a full workup, but nothing out of the ordinary was found. The case was referred to Dr. Foreman, but as Dr. House's medical licence had recently been restored, Dr. House took over the case. However, Dr. Chase and Dr. Cameron decided to resign from the hospital effective immediately, leaving only Dr. Foreman to work with Dr. House. Dr. House ordered a full STD panel, tox screen, a C-reactive protein test for inflammation, an ANA for autoimmune diseases, a medical history and a lumbar puncture to rule out encephalitis.
Dr. Foreman prepared the patient for the lumbar puncture. Hank denied any drug or alcohol use, although his wife did use marijuana. He also denied having a history of sexual abuse, clinical depression, psychosis or any other medical problems. He then complained that his arms were starting to hurt. Dr. Foreman realized it was tetany, involuntary muscle contraction. He ordered meperidine.
Dr. House went to Dr. Taub for a consult and described the patient's symptoms. He thought it might be a brain tumor or a seizure disorder as the brain is the only thing linking the eyes and muscles. He then sought out Dr. Hadley for a consult as well.
Dr. Foreman came to Dr. Chase for help doing the angiogram. He and Dr. Cameron agreed to help out. However, Dr. Cameron was not confident in the diagnosis. She was afraid that the angiogram could cause the blood vessels to spasm, and the steroids would allow an infection to spread. She thought it was Vitamin D deficiency - that could lead to hypoglycemia and photophobia. Dr. Chase agreed to treat him with ultraviolet light and vitamin supplements.
Dr. Cameron reported that Hank's blood wasn't clotting and the ultraviolet light had made his capilliaries more fragile, leading to DIC. Dr. Forman thought it was sepsis, but there was no sign of shock or drop in blood pressure. Dr. Chase thought it was bacteremia, but there was no fever and it wouldn't explain the muscle spasms. However, Dr. Cameron thought that pointed to meningococcemia. Dr. House ordered heparin and broad-spectrum antibiotics.
Dr. Chase started treatment, but Hank developed a fever. It was clear the antibiotics weren't working.
Dr. House sought out Dr. Taub for another consult, and during an argument, Dr. Taub realized that if Hank's sinuses were infected and clogged, the antibiotics wouldn't reach the infection if the blood vessels couldn't. He suggested doing surgery to drain them. Dr. Chase performed the surgery on Hank. They started him on antibiotics again. However, he started complaining about pain in his stomach. Dr. Cameron realized it was because his liver was failing. His abdomen also kept filling up with fluid. This ruled out meningococcemia. His medical history was clean, as was his family history of genetic diseases. As far as Dr. Foreman could tell, his parents always took him to the doctor whenever he got sick. Dr. Cameron thought a tumor was obstructing his bile ducts, but Hank wasn't showing jaundice and that wouldn't affect his eyes. Dr. Chase suggested sclerosing colingitis, inflammation inside the bile ducts. This would affect his clotting proteins, damage blood cells and cause small strokes. Dr. House agreed that it fit and ordered an ERCP as well as scouting for a liver donor.
Dr. Cameron broke the news to Hank that he would probably require a liver transplant and that it was unlikely to be approved given his current profession. Hank got angry with her and accused her of trying to morally judge him. He pointed out that doctors are exposed to far more illness than he is. However, his wife calmed him down.
However, Hank's lungs soon started filling with fluid to the point where he couldn't breathe. Dr. Chase applied suction to drain them and Hank was given oxygen. It appeared obvious that the strongyloides wasn't the only problem. Dr. Chase thought it was a blood problem, probably compounded with cardiomyopathy. However, Hank's neck veins were flat and his pre-cordial exam was normal. Dr. Foreman thought it might be lymphoma, a combination of peritonial carcinamatosis and paraneoplastic syndrome. Dr. House agreed and ordered chemotherapy. He also asked for a fax consult for Dr. Taub and Dr. Hadley.
However, Hank started urinating blood, indicating early stage kidney failure. His blood pressure started to rise and his heart rate rose to 250 bpm. He was soon in cardiac arrest. Dr. Chase used the defibrilator to stabilize him. The CBC showed practically no red blood cells, white blood cells or platelets. Minbendazol can have side effects, but usually not this severe. In any case, he had been off the drug for over a day. Dr. Chase suggested hypopituitarism, which can cause multi-system failure. However, his thyroid hormones were normal. Dr. Cameron suggested renal cell carcinoma, but the ultrasound was clean. Dr. Foreman suggested leukemia and Dr. House agreed, ordering radiation therapy to destroy the patient's remaining bone marrow. However, Dr. Cameron was opposed - Hank had no sign of anemia or being immunocompromised when he was admitted, and his white blood cell count on admission was normal as well. Dr. Foreman pointed out the treatment might kill him and would leave him open to being killed by an infection. Dr. House asked for a better idea. He then faxed Dr. Taub and Dr. Hadley for a consult.
Dr. Cuddy came to Dr. House to ask for alternatives before he irradiated the patient. He said he had no alternatives.
Hank was prepared for radiation therapy. Just before they started, Dr. Taub and Dr. Hadley called to tell Dr. House not to irradiate the patient. They had figured out that Hank's worsening symptoms after they treated the strongyloides could only be the result of the strongyloides actually being beneficial to him. Hank had extra-intestinal Crohn's disease. Hank's hygenic upbringing meant he was not exposed to normal germs when he was growing up. As a result, his immune system, with nothing better to do, started attacking his body's own cells. When he was afflicted with strongyloides, the immune system attacked those instead, until the treatment for them allowed it to start attacking his body again. Dr. House ordered methylprednisilone.
However, Dr. Cameron determined that Dr. House had figured out what was wrong with the patient long before Dr. Taub and Dr. Hadley called with the answer. She decided to resign from Princeton-Plainsboro.
Hank soon started to improve with treatment.