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Niles was vacationing in Bermuda when his stepdaughter was exposed to a centuries old medical sample. After returning to the United States, she started to develop fever, vomiting and bloodshot eyes. The attending physician Dr. House isolated Julie and put the rest of her family, Niles, Lulu and Roger, into a separate isolation room. Dr. House suspected that it might be smallpox as there were records showing that’s why the ship Julie was diving on was deliberately sunk. He ordered Niles vaccinated together with the rest of the family.
When Dr. Taub found pustules under Julie’s knee, he thought smallpox was more likely and contacted the CDC. However, Ms. Masters found a rash under her arm which appeared to rule it out. Nevertheless, Dr. Dave Broda soon arrived from the CDC and took over as attending.
Although Dr. House had been removed from the case, he was not certain Niles’s symptoms pointed to smallpox. He though the headache was head pain due to trauma. This would be consistent with tuberculosis, as would Julie’s symptoms. Dr. House wanted to do a CT Scan, but was aware that the CDC would not allow him to be moved to radiology. However, Ms. Masters told Dr. Broda that this would be the first opportunity to use a CT Scan on the brain of a smallpox patient. He agreed to it, but as they started to move him, Dr. Broda noted he had developed pustules as well. This meant he was too dangerous to move.
Niles vital signs continued to get worse. However, Ms. Masters was sceptical. Julie didn’t have pustules on either the soles of her feet or her palms, even though Niles did. She discussed it with Dr. House who realized that Nile’s kidney cancer may have returned. If that were the case, he would be immunocompromised and the smallpox vaccine might be causing his symptoms. However, if it were the vaccine, he would almost certainly recover. He wanted to treat him with interferon. However, this didn’t explain Julie’s condition.
Dr. House explained his diagnosis to Dr. Broda, but he was unconvinced. He thought it was far too dangerous to let anyone in the room. Dr. House pointed out that there was blood in Niles’s urine, but Dr. Broda put that down to the smallpox. Dr. House argued that if smallpox were causing the kidney failure, the urine would be brown from waste products. Against directions, and believing Niles wasn’t contagious House entered Nile’s isolation room without an isolation suit to administer interferon.
However, Niles didn’t improve on interferon. Dr. House was given an isolation suit because they couldn’t let him out of isolation. He administered more oxygen. The pustules continued to spread. Niles became convinced he was going to die. Dr. House allowed him the opportunity to say goodbye to his family. He soon lost consciousness and suffered a heart attack. Dr. House attempted CPR, but it was unsuccessful.
However, Ms. Masters continued to research the illness on the original ship and became convinced it was rickettsialpox. However, she could not convince Dr. Broda to start Julie on antibiotics. He also refused to look for eschars. Instead, she turned to Dr. House who took his gloves off to examine Niles’s body. He finally found the exchars on his back, confirming rickettsialpox. Julie was started on doxycycline and improved.