Matty is the young bone marrow donor who develops an illness just before he is about to give his marrow. He is the younger brother of Nick, who has recently received radiation treatment to destroy his remaining bone marrow so that he will be ready for the transplant. Nick suffers from leukemia. Matty is portrayed by the actor Dabier.
Case History Edit
Matty was preparing to give a bone marrow donation to his older brother Nick and Nick had been given radiation therapy to destroy his diseased bone marrow in preparation for the treatment. However, just as the marrow was about to be extracted, Matty started sneezing. Upon further examination, Matty exhibited an enlarged spleen and had a fever.
Given that any infection in Matty's bone marrow (even the common cold) would result in it spreading through Nick's immunocompromised body, Dr. Wilson approached Dr. House for assistance in identifying and treating the illness. The fever ruled out allergies as a cause of the sneezing. Although Nick was in a clean room, he would most likely not survive if he did not receive a transplant within the next five days. As Nick was African-American, the chances of finding another compatible donor were slim.
Dr. House found Dr. Foreman, who suggested the use of broad spectrum antibiotics. However, they would take at least a week to clear the infection from his system. Dr. Foreman next suggested testing Matty's stool and antibodies, but blood panels had already ruled out the most common infections. Dr. House suggested making the disease worse so they would see it sooner in blood cultures. Although this risked the infection spreading throughout Matty's body, once they identified it, it should be easy to treat. Dr. Foreman thought it would be safer to do an environmental scan first, but Dr. House believed that would take too much time. However, he allowed Dr. Foreman to do the environmental scan anyway.
Dr. Wilson and Dr. House approached the parents, Claudia and Scott, to consent to make Matty sicker. Although they were concerned about Matty, Dr. Wilson and Dr. House convinced them it was the only way of finding out what was wrong in time for the transplant. Dr. Chase and Dr. Foreman did the environmental scan but found the house was very hygenic and there seemed to be no source of infection. Dr. Foreman thought the soil might contain mucormycosis or strongyloides, but Dr. Chase pointed out there were no pulmonary symptoms. However, they did find an old water well on the property and took samples.
Matty was given leukapheresis and exposed to cold in order to weaken his immune system. Dr. Foreman and Dr. Chase asked Matty about the well, but although he had drunk from it last summer. This appeared to rule out microbacterial leptospirosis. Matty started complaining about shoulder pain, but this was put down to muscular/skeletal strain. However, he also complained that his scrotum was sore as well, and his testicles were enlarged. This narrowed down the possibilities to E. coli, brucellosis, tuberculosis, klebsiella, enteroviruses and adenoviruses. Dr. House ordered urinalysis, blood cultures and blood tests. Dr. Foreman also wanted to see if there were an alternative donor for Nick.
However, all the tests were negative. Matty's fever and mucous production clearly indicated infection, but Dr. Chase wondered if the issue with the scrotum was not a primary symptom of the disease. He looked over the tests and they showed Matty's CKMB was slightly elevated. Dr. Chase was worried that the infection had spread to Matty's heart. He and Dr. Cameron did an endoscopic echocardiogram and found a growth on Matty's mitral valve. They realized Matty would need to be on antibiotics for a month to clear that up.
The heart infection appeared to rule out Matty as a bone marrow donor. However, Dr. House suggested that they replace Matty's mitral valve, even though he didn't need a new one. Once they examined the growth, they could immediately identify the disease. They could then extract Matty's bone marrow, mix it with the targeted antibiotic, and give it to Nick. Dr. Wilson agreed with the plan, but Dr. Foreman wanted to check this with Dr. Cuddy. Dr. Foreman and Dr. Wilson went to Dr. Cuddy with Dr. Foreman arguing that Dr. Wilson was in a conflict of interest because he was treating Nick, and Dr. Wilson saying that there was no conflict because it was the parents who would make the decision anyway. Dr. Cuddy sided with Dr. Wilson and told him to get the parent's consent, but only if Dr. House was not allowed to pressure the parents. Dr. Cuddy admitted to Dr. House that she did not believe Dr. Foreman had a strong enough case and asked why he let Dr. Foreman argue the point. Dr. House was afraid that Dr. Foreman was becoming timid because of the death of their previous patient.
Dr. Wilson explained the risks to the parents. Because Matty would have to be on blood thinners for the rest of his life, he would no longer be able to participate in sports, but otherwise he would be fine. The parents agreed to the surgery.
Dr. Cameron came to prepare Matty for surgery. He was put under anesthetic and put on heart-lung bypass. However, the biopsy showed only fibrous tissue, no infection. They cancelled the heart valve replacement and Dr. House was informed of the result. He came back to the hospital and started a new differential. They realized an infection may not be the culprit, but something was turning healthy muscle into the equivalent of gristle. Dr. Cameron thought it might be an autoimmune disease. If that were the case, Matty's illness would be non-contagious. Once they confirmed the illness, he could still be a donor. Dr. House ordered tests for lupus and Bichette's disease. However, Dr. Foreman still thought it was an infection. He noted that the chances of two brothers having two different genetic diseases was unlikely. He also noted that he had found a 4/6 match in the bone marrow registry for Nick. However, Dr. House pointed out a 4/6 match posed a very high risk of graft versus host disease. He ordered tests for autoimmune diseases.
Dr. Cameron assured the parents that if it was autoimmune, it would be very good news for Nick. Moreover, it would only take a few hours to test for all the possibilities. However all the tests were negative and Nick's health was starting to deteriorate - he had bruising all over his arms. If the bleeding spread into Nick's brain, he would die. Dr. Cameron suggested they go with the 4/6 match. However, Dr. House was insistent that the 4/6 donor was a bad idea and wanted to keep looking for the infection.
However, Dr. Foreman was suggesting the 4/6 donor to the parents. When Dr. Wilson and Dr. House found out about it, they explained how dangerous it was, but the parents were aware Nick could start bleeding into his brain at any time. They directed Dr. Wilson to focus on treating Matty and to give Nick the 4/6 transplant. When Dr. Wilson complained to Dr. House about Dr. Foreman approaching the parents without discussing it with him first, Dr. House said that Dr. Foreman was only doing what he thought was right and Dr. Wilson merely found it easier to accept that rather than to tell the parents that Dr. Foreman was acting improperly.
Dr. Foreman extracted the bone marrow from the donor and started the transplant process with Nick.
They started Matty on several different medications. Other than an itch he had no further symptoms. He was upset when he found out he could not go and see Nick because he was still sick. The itch started to get worse and Dr. Cameron noted that Matty was bleeding out of his ear. His blood count was way down and his shistocytes were up, indicating he was no longer producing blood. Either the medication or the infection was suppressing Matty's bone marrow. He realized he had to stop the medication to see whether it was the medication or the infection affecting the bone marrow.
In addition, as expected, Nick had developed graft vs. host and had blisters all over his feet and legs. Dr. Chase had already increased the dosage of methylprednisilone, but it was having no effect. Matty's blood count was still dropping even after his medication was discontinued - it had to be the result of the infection. There were still no results from the blood cultures because there still wasn't enough of the infection in his blood, most likely because of the treatment they had given him. However, Dr. House realized that if Nick were given the infection, it would grow faster in him and show them what it was. Nick was likely to die anyway.
Dr. Wilson and Dr. House went to the parents to let them try infecting Nick. Dr. Wilson explained that Nick was not responding to treatment for graft vs. host disease and was likely to die anyway. However, the parents were convinced Nick had a chance. Although both Dr. Wilson and Dr. House told the parents they should let them try, the parents refused to consent.
Dr. Foreman wanted to keep running more tests, but Dr. House thought it was a waste of time as there were thousands of possibilities. However, Dr. Wilson thought it was worth a shot. Dr. Foreman went to run tests and Dr. Wilson, Dr. Chase and Dr. Cameron went to help him.
Dr. House went to see Nick to tell him that he was going to die and that the painkillers would not help him. He asked him to allow the doctors to infect him so they could find out what was wrong with Matty. Nick tried to convince his parents, but they held out hope for him. However, they finally agreed.
Meanwhile, Dr. Foreman and Dr. Wilson kept testing. Dr. Foreman realized it couldn't be a food-borne infection because Matty's parents weren't sick. They had eliminated pseudomonas and cholera from the water pump, but Dr. Wilson asked why the house had a water pump - it was in a suburb with municipal water. Dr. Foreman realized that the house used to sit on a farm - a breeding ground for histoplasmosis, a fungus. They managed to stop infecting Nick just in time and get him back to the clean room. Matty was given amphotericin and was expected to make a full recovery. However, Matty still couldn't donate because the histoplasmosis had affected his own marrow and there wasn't enough left to give to Nick.
However, Dr. Foreman went to see Matty. He told him that there was a way to save Nick, but it would mean that Matty would have to risk his own life. Matty agreed. Dr. Foreman explained that he could not sedate Matty due to his illness. Dr. Foreman strapped Matty to the hospital bed and grabbed the large needle used to extract marrow and started the procedure on Matty. Matty cried out in pain but Dr. Foreman wouldn't stop until he had enough marrow.
The marrow transplant went well and Nick started to recover. The parents were angry with Dr. Wilson, but soon calmed down once both Matty and Nick had recovered to the point where they regained their appetite. The prognosis for both of them was good.