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Iris had a history of mood swings. She was in a car accident at the age of two. She suffered only minor injuries, but her father died.
Iris suffered intermittent idiopathic anaphylactic reactions. Two of the doctors in the emergency room could find no cause. An immunologist from Johns Hopkins Medical School was similarly stumped. She was transferred to Princeton-Plainsboro Teaching Hospital where Dr. Foreman referred the case to Dr. House. He handed the case over to his team to work on another case.
Dr. House’s team reviewed the file. The patient’s first reaction was at her 14th birthday party. The last thing she ate before the attack was strawberry cake, but she tested negative for a strawberry allergy and all other common allergies. Dr. Adams thought it might be hereditary angioedema or systemic mastocytosis, but there were no skin lesions and her complement studies were normal. Dr. Adams thought her elevated blood pressure could indicate a pheochromocytoma, but Dr. Taub thought it might be anaphylaxis triggered by opiates. The patient didn’t appear to be on any medication and her tox screen was clean. As senior fellow, Dr. Chase decided to test Iris’s catecholamines for the pheochromocytoma and an extended opioid panel. He also told them to ask the patient about drug use after her mother left the room.
The patient denied ever taking drugs, only Vitamin C. She said the attack occurred when she opened her birthday present, a Magic 8-Ball. However, when Dr. Taub talked to her mother Faye, she told him she was giving her diazepam, but told her it was Vitamin C. This would explain her symptoms. However, Iris started to vomit, which appeared to rule out diazepam.
Dr. Adams performed a physical examination. Iris said she had some pain when Dr. Adams compressed her abdomen, but also had pain on the right side of her chest. Dr. Taub realized that Iris’s breasts were tender and asked if she was having regular periods. She said she was not. He proposed a pregnancy test. Iris denied ever having sex, but Dr. Taub and Dr. Adams told her mother that pregnancy would explain all the symptoms. Dr. Adams assured her it would only require one drop of blood, but when she touched Iris’s arm to reassure her, Iris complained that she couldn’t feel or move her arms - paresthesia
Dr. Adams reported to Dr. House that Iris was pregnant. Dr. Taub thought the arm paralysis was the result of a cerebral tumor, but Dr. Adams thought it was vasculitis and Dr. Park though it was multiple sclerosis. Dr. House noted that vasculitis and MS usually get better with pregnancy. Dr. Chase suggested it might be an STD - HIV related mononeuritis multiplex. Dr. House ordered an HIV test and an MRI to look for tumors.
The HIV test was negative, as was the MRI. However, after the test, Iris reported her arms were sore. This showed the paresthesia had disappeared, but when they examined her, they found large bruises on her upper arm. Trauma appeared to be ruled out as the cause of so many bruises as they would have required several blows. Dr. Park suggested a blood disorder like thrombocytopenia. Dr. Adams suggested that both Vitamin K deficiency and scurvy can cause bleeding problems. Dr. House ordered Dr. Chase and Dr. Taub to do an environmental scan and Dr. Adams and Dr. Park to run lab tests.
Dr. Taub found a lot of spinach and broccoli in the patient’s home, which appeared to rule out Vitamin K deficiency. However, when Dr. Chase searched the patient’s room, he found love letters and hard-core pornography.
Iris was confronted with the letters and pornography and admitted she met a boy at school, but denied ever having sex with him. She said the pornography was his and he couldn’t keep it as his place. However, she admitted that he came there the previous night and he hit her when she refused to leave the hospital. This explained her bruises. However, she refused to tell anyone who her boyfriend was and said she would deny he did anything. Iris then started to complain that it was getting difficult for her to see.
However, Dr. House soon came to see the patient. He asked about the MRA and guessed that it was normal. He then told the patient that he had gone to see her boyfriend and, when he had seen Dr. House coming, he ran away and was hit by a car. The patient called him a liar, but Dr. House insisted that he was down in the emergency room that very moment. She then called him a lying sack of crap. Her mother rebuked her about her language, but Dr. House asked her how she knew he was lying and how she knew he was okay. She replied “because I‘m right here you dick“.
Dr. Chase told Iris and her mother that Iris had dissociative identity disorder, most likely the result of a severe trauma. Dr. Taub thought it might be the car accident she was in when she was two. Iris denied being able to remember anything about it. They explained the personalities only came out when she was afraid or anxious, which is why Dr. House faked the story about the boyfriend. The bruises were most likely self-inflicted. She probably got pregnant during a period when one of her other personalities was in control and she didn’t remember the sexual encounter. The diazepam her mother gave her for the mood swings most likely masked the problem, and when she was taken off it, the personalities reasserted themselves. Iris’s mother had to admit she had given her the diazepam. Dr. Chase explained to her that many of the symptoms could be psychological ones expressed by other personalities. He suggested hypnosis to sort out which of the symptoms were psychological.
Dr. Chase found a personality of a little girl who couldn’t move her arms. She said she always felt hurt after eating strawberries and she remembered the accident - she was restrained in her car seat and blamed herself for the accident that killed her father because she distracted him with her crying. She was eating strawberries at the time. She remembered her father being conscious and telling her everything was going to be okay. They then noticed that Iris was bleeding profusely from her vagina.
They ruled out a miscarriage as the source of the bleeding as Iris still had a positive pregnancy test. They started ruling out symptoms that weren’t reported by all three personalities - pregnancy, vaginal bleeding and elevated blood pressure. Dr. Park suggested preeclampsia, but Dr. Adams thought it might be an ectopic pregnancy. Dr. Chase realized they needed to do an ultrasound. However, the examination revealed no embryo.
Dr. House thought that one of the doctors had screwed up the pregnancy test, but Dr. Adams assured him that three different doctors had done three different positive tests. Dr. House finally realized that they don’t test the blood for pregnancy, but only for elevated HCG levels that occur with pregnancy or, more rarely, choriocarcinoma. Choriocarcinoma would explain all the symptoms, but since it didn’t show up on the ultrasound either, it had to be barely visible. Dr. House told his team to inform the patient she probably had cancer.