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Jack Walters is the patient in the episode Whac-A-Mole who keeps developing new infections once old ones are treated. Jack is the legal guardian of his younger siblings Kama and Will. He is portrayed by Patrick Fugit, best known for his portrayal of William Miller, a young reporter for Rolling Stone magazine in Almost Famous based on real life teenage reporter Cameron Crowe.
Medical History Edit
Jack had a history of drug abuse and smoking as a teenager, but he quit cold turkey after he was informed his parents had died in an automobile accident.
Case History Edit
Jack was brought to the emergency room of Princeton-Plainsboro Teaching Hospital after he vomited and collapsed at work, clutching his chest. The paramedics had to defibrilate him in the field to stabilize his heart.
The case was referred to Dr. House. Jack had suffered a heart attack, but the heart catheter was clean and an echocardiogram showed no structural abnormalities. The patient reported fatigue, night sweats and weight loss preceding the heart attack. Dr. House believed stress would explain all his symptoms except one - itchy feet. However, Dr. Cameron thought this could be explained by the fact that he was on his feet all day as a waiter. Dr. Foreman noted that despite anti-emetic therapy, the patient was still vomiting. This could be explained by increased intracranial pressure or a tumor. However, Dr. House noted these would not explain his heart problems. Dr. Chase thought it was merely an intestinal virus - the patient worked in a restaurant full of young children. An electrolyte imbalance led to arythmia that led to the heart attack. However, Dr. House disagreed with them all, but allowed them to run one test each as a learning exercise, but he believed he knew what was wrong with the patient. He wrote down something on a piece of paper.
Dr. Foreman thought it might be drugs, but the patient quit doing drugs when his parents died. Dr. Chase thought it might be a bacterial infection and decided to do blood cultures. Dr. Foreman decided to do an MRI to look for a tumor.
Dr. Chase went to take blood from Jack, and his brother Will mentioned he had also had a stomach ache. However, Jack didn't think it was related. Dr. House came to see the patient and his family and asked if his feet still itched. Dr. House asked about drugs and Jack again repeated he quit them so he could take care of his younger siblings.
Dr. Foreman performed the MRI. Dr. House came in to tell Foreman he was probably wrong. He asked the patient how he quit smoking, but he said he just lost his taste for them. The scan was clean.
Dr. Cameron decided to try to see if a spasm in the blood vessels around his heart caused his heart attack. She injected Jack with ergonovine and asked him to report any unusual sensations so she could identify damaged arteries. Dr. House supervised the procedure and suggested that since there didn't seem to be any reaction, that she should stress the patient. She started to get him upset about his job situation, which raised his heart rate. However, there was still no spasm.
All the team's tests were negative, but Dr. House slipped in an extra test into the blood cultures and the patient had tested positive for hepatitis A. Persistent vomiting, itchy feet and a distaste for nicotine are symptoms of the disease. Dr. Chase was right about one thing - the persistent vomiting could lead to a heart attack. He ordered intravenous immunoglobulin. When the team checked what Dr. House had written, it wasn't the diagnosis, but he had accurately predicted what test they would run.
The patient improved on IVIG and Dr. Foreman told Jack to make sure he checked with all his sexual contacts to make sure they weren't infected. However, as Dr. Foreman was discontinuing IVIG, Will noticed Jack's arm was bleeding. Dr. Foreman instructed Jack to raise his arm above his head to slow down the flow of blood. Kama noticed his ear and nose were bleeding too.
Jack's PT and PTT on the blood panel were high, indicating a coagulopathy and DIC. Dr. House realized it could not be the hepatitis - it had to be something else. Dr. Cameron thought it might be an environmental bacteria, such as E. coli, eikenella and streptococcus. Dr. Chase suggested a food borne toxin. However, Dr. Foreman noted that no-one else associated with the restaurant was sick. Dr. Foreman though an STD was more likely. Dr. House directed Dr. Chase to return to the restaurant to try to recover Jack's vomit to test for toxins. Dr. Foreman was directed to perform a lumbar puncture and then get Dr. Cameron to test for the bacteria she suggested. Dr. Chase suggested checking Jack's blood for common toxins, but Dr. House noted that given the amount Jack had vomited, there would be no toxin left in his system by now.
Dr. Chase went to the restaurant and asked one of Jack's co-workers if Jack had any special duties. However, Jack did the same jobs all the other waiters did. The restaurant used non-toxic cleaning materials to avoid accidentally poisoning the children who were their main customers. They located the trash that contained the vomit, but Dr. Chase had to find it himself.
Dr. Foreman performed the lumbar puncture with Kama's help. Kama was worried that Jack was going to die, but Dr. Foreman reassured her. However, she remembered that her father often drank and drive and said that would be okay as well. Dr. Foreman assured her that Jack was not in immediate danger. However, as Dr. Foreman was rolling Jack back on his back after the procedure, one of his ribs broke.
Dr. Foreman reported this development to Dr. House. He realized the patient had osteomyelitis - an infection in his bones. Dr. Foreman had already performed a needle aspiration. They went to the lab to tell Dr. Chase to stop testing for toxins. Dr. Foreman looked at the blood test printouts that had just arrived, which showed Syphilis, just as he thought. However, Dr. Cameron had already just confirmed he had achinella as well. Dr. House instructed Dr. Chase to keep working on the food borne toxin test as well, and to their astonishment, the patient was positive for botulism as well. Despite the successful treatment of the hepatitis, the patient had three new infections.
They managed to treat all three diseases, but then Jack started having seizures every few hours. Dr. House thought he might be immunocompromised, but his white blood cell count was normal and he was negative for HIV. There was no explanation for the seizures - the CT Scan and focal neuro exam were normal and there was no electrolyte imbalance. However, Dr. House noted that unexplained seizure and his young age would point to drugs in any other case. The patient admitted to prior use and drugs may have become trapped in his fat cells. A tox screen only tests blood and urine. Jack was not eating because of digestive issues and was continuing to lose weight in hospital and this may have released the drugs from his fat cells as he metabolized them for energy. As fat cells could not be tested for drugs, Dr. House suggested putting him in a hot environment, like the hospital's sauna, to drive the toxins out of his fat.
Jack was taken to the sauna and was supervised by the team to ensure he had medical attention if he had a further seizure or heart attack. He admitted that he was high when the police came to tell him about his parents and the first thing he did was laugh. Jack had another seizure and they took another blood sample. However, it tested negative for drugs.
Dr. Foreman reported the test results to Dr. House. Dr. House felt that since the infections had been treated and he was still having seizures, it must be a problem with his brain. Dr. Foreman reminded him that the brain scans had been clean, but Dr. House insisted on another scan given the patient's new symptoms.
Jack wondered why he was getting another head scan and was afraid he was not going to recover. He was worried about his siblings, but Dr. Foreman reassured him. However, the scan showed numerous small tumors throughout Jack's brain.
Dr. Cameron though that Jack had brain cancer which destroyed his immune system, making him susceptible to infections. Dr. Chase suggested radiation treatment, but Dr. House noted this would destroy whatever might be left of his immune system. Dr. House was suspicious about the tumors because they grew so quickly and suggested they might just be pus. However, the pus would have to come from an infection and Jack had already been on a full course of both IVIG and antibiotics. However, Dr. House noted it would not have affected a fungus. He ordered a biopsy of one of the masses.
The biopsy showed the masses were each an abcess from aspergillis. Dr. House figured it had to be a genetic disease. His team objected that this would have been a lifelong problem, but Dr. House pointed out that several genetic disorders can be triggered by later emontional trauma, such as that suffered by Jack when his parents died. However, there were still several possibilities. However, hepatitis A indicated a problem with B-cells. Achinela indicated a complement deficiency. The Syphilis could indicate chronic granulomatous disease. The aspergillis would indicate common variable immunodeficiency. Dr. Chase pointed out that genetic testing would probably take more time than the patient had. As such, Dr. House came up with an idea - deliberately expose Jack to different infections and find out which one he was most succeptible to.
Jack agreed to be exposed to a mixture of serratia, meningococcus, cepacia and rhinovirus. Which ever showed symptoms first would indicate what genetic disorder he had. The team took turns observing Jack, and while Dr. Foreman was attending to him, his lungs filled with fluid from the serratia, indicating chronic granulamatous disease. Dr. Foreman administered oxygen.
The only possible long term treatment was a bone marrow transplant to re-establish his immune system - otherwise, Jack would continue to get new infections. Will turned out to be a match but when Jack found out, he objected to both the testing and to Will being a donor. Dr. Foreman explained that he would continue to get sick all the time, even though his illnesses would most likely be treatable. His life span would also be shortened. Jack still objected to Will being a donor despite the low risk to Will because of his age. He said Will could decide for himself when he was 18.
Dr. House figured Jack wanted to escape from having to take care of his siblings, but Dr. Foreman thought he was wrong. To test Jack, Dr. House told him they had found another compatible donor. However, Jack refused to agree to the procedure, ostensibly because he was afraid of the risk from the transplant. However, he finally admitted that felt he was too young to take care of them. Dr. House supported his decision.
Jack broke the news to Kama and Will that he couldn't take care of them any more. Dr. Foreman told him that he probably wouldn't realize how much he missed them, and in a few months he might feel differently.