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Jerry came to Princeton-Plainsboro Teaching Hospital after his daughter came home from school and he realized that he could not remember what he did for most of the day. He thought only a few moments had passed since she left the house seven hours earlier. The next thing he knew it was several hours later.
Dr. Cuddy brought the case to Dr. House telling him that the patient had suffered from recurring blackouts. Dr. House thought it was alcohol abuse, but the emergency room had already ruled out drugs and alcohol. Dr. House next suggested epilepsy, but his EEG and CT scan were both clear. Dr. House agreed to take the case.
Dr. House brought the case to his team. Dr. Hadley suggested it might be post-concussion syndrome, but there was no medical history suggesting Jerry had ever had a concussion. Dr. Taub suggested a series of small strokes, but Dr. Hadley pointed out that a small stroke would not account for a blackout of nearly nine hours. Dr. Hadley pointed out that Jerry worked as a product tester - he may have been exposed to something that caused short term memory loss. Dr. Kutner pointed out that a cavernous sinus thrombosis could cause an absence seizure. Dr. House ordered an environmental scan and an examination of the sinuses.
Dr. Hadley and Dr. Taub did the environmental scan of the house. It was in like new condition although they had lived there for six years. They found no alcohol, pharmaceuticals or illegal drugs. However, Dr. Hadley did find some mold hidden behind some moulding.
Dr. Hadley went to test the daughter for mold exposure, which can cause short-term memory loss, although the daughter said she felt fine. Dr. Hadley questioned the daughter about the family's social life, but she told Dr. Hadley that her father spent almost all of his time at home working, and she just went back and forth to school. Her mother had died in an accident when she was 4, but she said she didn't see what the big deal about death was. Dr. Hadley expressed her concern about the daughter's lack of emotional state to Dr. Foreman, but he put it down to her being upset about her father being sick. All of a sudden, they saw Jerry trying to leave the hospital. He insisted he had to leave. Dr. Foreman shined a light in his eyes and found that his pupils were responsive, so it wasn't a seizure, but he though Jerry was sleepwalking.
They realized the blackouts were do to his being asleep. Dr. Taub thought the sleepwalking was merely a symptom of stress induced insomnia, but Dr. Foreman said it was unusual for someone to fall asleep in the middle of the day when they weren't even resting. Dr. Kutner suggested that sleepwalking usually has a genetic component, or it is triggered by environmental factors like a toxin. The mold couldn't have caused the sleepwalking and there was nothing else at his home. Dr. Hadley pointed out the patient never left his home, but Dr. House pointed out the only reason they assumed that was because the patient told them. If the patient was leaving his home in his sleep, just as he tried to leave the hospital, it is likely he was being exposed to something else. He suggested taking Jerry home and following him the next time he left.
Dr. Taub and Dr. Hadley went to monitor Jerry at his home. He finally fell asleep and started towards the door. They followed him to a drug dealer who was selling cocaine. Unfortunately, they were unable to intercept Jerry before he took the drugs.
They reported back to Dr. House. Cocaine would cause narcolepsy, which could lead to sleepwalking. However, Dr. Foreman pointed out cocaine would not explain why he started sleepwalking in the first place. Dr. Hadley suggested the patient lied about his drug use - he started using cocaine and the sleepwalking came later. However, Dr. Kutner pointed out the patient had no motive to lie about drug use. However, Dr. House suggested the cocaine may have been cut with another substance that caused the memory loss - the patient simply forgot he started using cocaine. He wanted the cocaine tested, but they did not have a sample. Dr. House directed Dr. Taub and Dr. Hadley to get a sample.
Dr. Taub and Dr. Hadley tracked down Jerry's drug dealer and Dr. Taub managed to buy a sample. However, Dr. Hadley tasted a sample and found it to be pure cocaine. She went back to the dealer to ask for an adulterated sample.
The cocaine sample tested positive for milk powder - lactose. Dr. House figured Jerry might be lactose intolerant. He directed Dr. Taub and Dr. Hadley to ask the patient and treat him for an allergic reaction.
Jerry seemed to improve - he was able to keep track of time and all the monitoring equipment showed he was reacting normally. Dr. Taub told him the cocaine was probably causing all the problems and he should continue to improve. Jerry was upset with himself for taking cocaine, but Dr. Taub assured him that he was asleep at the time. However, Dr. Taub noticed a red patch on Jerry's chest. On further examination, it turned out to be blood, but Jerry showed no sign of a cut or other injury. Dr. Taub realized that Jerry must be sweating blood.
Dr. Taub reported the result to Dr. House, who realized the blood couldn't be explained by cocaine or allergies and, if it continued, would lead to death. Dr. Kutner realized that Jerry must have a systemic disease, like a hemorrhagic virus. However, if that were the case, his white blood cell count would be very high. Dr. Kutner suggested DIC, but the patient's blood tests showed normal coagulation. Dr. Taub realized leukemia would explain all of his symptoms. However, Dr. Kutner pointed out the patient wasn't suffering from fever or weight loss, had no headache and would have been obvious from the CBC they had performed. Dr. Taub pointed out the CBC isn't always definitive for leukemia. Dr. House agreed and ordered a bone marrow biopsy.
As Dr. Kutner and Dr. Taub started the biopsy, Dr. Taub noticed one of Jerry's legs was noticeably darker than the other one. After ruling out the use of tanning products, they realized Jerry didn't have leukemia and terminated the procedure.
Dr. Kutner performed a chem panel which confirmed the late stages of kidney failure. They couldn't start Jerry on dialysis because his blood pressure was too low. Dr. Kutner suggested hemochromatosis, but he didn't exhibit hypogonadism. Dr. Taub suggested scleraderma, but this would have made Jerry's skin lighter. Dr. House thought it ight be vasculitis given that the patient was bleeding from everywhere. He ordered tests for vasulitis, an angiogram and blood tests. Dr. Kutner pointed out that Jerry would need a kidney transplant. Dr. House suggested the daughter even though at age 12 her kidneys would be undersized. However, Dr. Kutner pointed out that the daughter would need a guardian ad litem to explain the risks.
Dr. House went to get Dr. Cuddy, but she was busy in surgery overseeing the birth of the child she hoped to adopt. After she was finished, she agreed to speak to the daughter, but told Dr. House to be quiet and not pressure her. After she was convinced that the daughter understood the risks, she was willing to sign off. However, Dr. House noticed that her manner was unusual and examined her further. He realized she was sleepwalking and that whatever her father had, she had it too.
Dr. Kutner reminded Dr. House that Jerry would be dead in a week without a new kidney. However, Dr. House pointed out that if the daughter had the same problem, her kidney wouldn't help her father. Dr. Taub suggested that the sleepwalking could be the result of other common factors like caffeine or noise from the freeway they lived near, but Dr. Hadley came to report that the daughter was now sweating blood too - it was clear they were both suffering from the same disorder. However, Dr. Hadley pointed out that if they both had it, it had to be a toxin, infection or genetic disease. The first two had been eliminated. However, Dr. Kutner pointed out there were still a dozen possible genetic diseases that could account for the symptoms, and each of them took more than a week to test for. Dr. House ordered them to start testing.
Dr. House went to Dr. Wilson for a consult, but they started talking about Dr. Cuddy's new baby and how happy Dr. Cuddy was. All of a sudden Dr. House realized something and walked out.
He went to the patients and told them he realized what they had and that they were going to be fine. He then admitted he was lying about the second part - he just wanted to see if they would be happy, but they weren't . He realized they were suffering from anhedonia - something was attacking their dopamine receptors. Dr. Hadley put it down to depression over the death of the mother, but Dr. House also pointed out they had no friends and they seemed indifferent to each other's problems. Dr. Taub realized that their home had no music, view (except of a freeway) or decor. Dr. Foreman pointed out the most likely cause of anhedonia is schizophrenia, but Dr. House pointed out that was only true of people of European descent. He asked Jerry what his real name was and he finally admitted it was Jamal Hamoud. He told the patients they had Familial Mediterranean fever, a genetic disease limited to persons of Mediterranean descent that comes on when a person is either older, like Jerry, or under stress, like his daughter. Unfortunately, one it reaches the stage where patients sweat blood, treatment is not always successful. He started them on colchicine amafalan. Dr. Foreman pointed out that if it wasn't FMF, the colchicine would destroy Jerry's kidneys for good. Dr. House instructed him to start anyway.
Jerry and his daughter were started on treatment, but were slow to respond. However, several days later Jerry regained consciousness and asked about his daughter. She was fine and smiled at her father, who smiled back. They planned to complete the kidney transplant and a full recovery was predicted.