Original airdate: 12/28/2004
Initial symptoms: excessive sleeping, extreme irritability
comes home from jogging with his friend to find his wife, Elyse, still
in bed at 4 o'clock in the afternoon. He tries to wake her, but
all she does is mumble for him to call in sick for her. He persists,
mentioning that she has not been to work or gotten out of bed for three
days. She becomes increasingly irritable, finally slapping Ed in
the face. She wakes up enough to realize something is wrong with
Cameron tries to persuade House to take the case, pointing
out that Elyse has been sleeping 18 hours a day since her admission.
House dismisses this as a symptom of clinical depression. Cameron says
Elyse has been seen by three ER doctors, two neurologists, and a
radiologist, none of whom can figure out the cause of her ailment.
She mentions that the blood work shows no signs of inflammation,
but House interrupts, clearly disinterested.
Cameron is so
persistent that House becomes interested in her interest in the
case. When the rest of the team is presented with the case, Foreman's
first reaction is to ascribe Elyse's hypersomnia and irritability to
depression, as well. House rules out depression because Elyse has a fever.
Cameron notes that an elevated sed rate indicates inflammation (despite
what she read out of the same file a moment earlier). Foreman thinks
her symptoms of hypersomnia and personality changes indicate a brain
problem. Cameron says that no other signs of inflammation make
vasculitis unlikely. Chase suggests a parasitical infection,
possibly malaria or Chagas, but Cameron notes that Elyse has never been
outside of the United States. Chase notes that she only claims she's
never been outside the US, but Cameron says the blood and CSF smears
show no signs of parasites.
House suggests a tumor, but Foreman
thinks it is unlikely that the previous doctors would have missed
such a thing. House orders new blood work and an MRI with
two-millimeter cuts through the mesodiencephalic. Elyse finds
this news distressing, despite Ed's attempts to comfort her. After the
MRI, Foreman reports that there are no visible lesions or mass
effect, but it means they still don't know what's wrong. Moments
later, as Ed voices his frustration, Elyse has a seizure. Cameron calls
for Ativan. Elyse begins aspirating, and Foreman starts suction.
later, Foreman administers a test in which Elyse must draw circles and
triangles, with which she has great difficulty. Wilson reviews the MRI,
but he says it reveals nothing. Foreman notes that a small glioma
might be missed by the contrast, and suggests a PET scan. House
thinks A PET scan would be a waste of time, noting that for a glioma to
be missed on a contrast MRI, it would have to be smaller than a grain
of sand, which would not make someone as sick as Elyse.
suggests that Elyse is having postictal disorientation, but Cameron
thinks Elyse's condition would have improved by this time. Chase then
suggests late-stage Lyme disease as a cause of seizures. House asks how
devoted Ed is to her, and rules out Lyme disease, noting that a husband
as devoted as Ed would have noticed the characteristic rash.
asks if they have examined Elyse's breasts, suggesting paraneoplastic
syndrome from breast cancer. House accepts this possibility, as Elyse's
mother died from it. Elyse is considerably alarmed during the
mammogram. She tells Cameron that her mother was the same age as she
when she died. Cameron tells Elyse that much has changed in the
intervening years, and not to give up hope.
The mammogram and
MRI showed no cancer, only benign calcifications. Wilson thinks it is
most likely a small-cell tumor which is difficult to find, and they
should now do a PET scan of her lungs, and possibly her bones. He also
mentions that paraneoplatic syndrome can occur with no tumor. This
puzzles Chase, and Wilson tells him that this happens with 12% of
cases. Those patients, House notes, do not receive any treatment.
House wants to treat Elyse's symptoms with IV immunoglobulin. Foreman
seems to dislike the idea of not looking further for a tumor, but House
points out that if there is one, it will eventually get bigger.
asks Foreman to check out Elyse's workplace. Since Ed is not sick, if
Elyse was exposed to a toxin, it would not have happened in the home.
Meanwhile, Cameron is tending Elyse while Ed is out of the room.
Cameron asks her several questions to test her memory. During this
test, Elyse complains of itching from her IV site. Cameron thinks
this is a mild irritation for which she will bring hydrocortisone
cream. She continues the memory questions, but Elyse says the itching
has become more severe. As Cameron turns to leave for the cream, Elyse
imagines a large bulge on her arm, which bursts, releasing hundreds of
tiny spiders. Elyse begins to scream and thrash, begging for
someone to get the spiders off her. Cameron calls for five milligrams
of Haldol. Elyse's outburst intensifies when she imagines the spiders
are biting her. Cameron tries to tell Elyse there is nothing on her, to
no effect, as Elyse can still see and feel the spiders. Cameron,
Foreman, Ed, and three nurses rush to sedate and restrain her, to
prevent her from ripping her skin off.
Wilson says that
"creepy-crawlies" are consistent with paraneoplastic syndrome, but
Cameron notes that the hallucination statred immediately after the IVIG
was administered. House thinks this reaction could indicate an
infection. Foreman counters that the blood cultures rule out most
bacteria, serololgy rules out viruses, and the blood and CSF smears
showed no parasites. House points out that in the final stage of
African trypanosomiasis, almost all of the parasites would be inside the
brain, and likely wouldn't show up on smears.
Foreman thinks it
is highly unlikely that a person who has never been to Africa would
contract this disease, despite it fitting the symptoms. Wilson
notes that it is possible to to get the disease from a transfusion, but
Elyse has never had one. Wilson asks about toxic exposure from Elyse's
workplace. Foreman says the kitchen Elyse works in is immaculate,
though her job as a rotisseur exposes her to rabbit meat, and suggests tularemia, also called rabbit fever. Chase
points out that tularemia would present with a rash or ulcer at the
site of infection, but Foreman thinks it is possible she inhaled the
bacteria and dismissed any respiratory symptoms as a common cold.
Since they have narrowed the possibilities to either tularemia or African
trypanosomiasis, Cameron suggests treatment for both. Chase points out
that the treatment for tularemia can cause aplastic anemia and the
treatment for Sleeping Sickness kills 10% of the patients.
Epiphany: It occurs to House, while he is advising Mrs. Campbell that African
trypanosomiasis can be sexually transmitted, so it is possible she
contracted it that way. House read about such a case in the Journal of
the Instituto de Higiene e Medicina Tropical.
sends Chase and Foreman to question Ed and Elyse separately. Both
adamantly deny having an affair. The team starts her on IV
chloramphenicol for tularemia, despite Elyse's lack of recent
respiratory symptoms. While Cameron changes Elyse's IV, Elyse lapses
into a coma. House states that the coma while on the medication means
Elyse does not have tularemia, and that it must be Sleeping Sickness.
House speaks to Ed alone. He again denies having an affair, a expresses
his trust in his wife. House impresses on Ed the necessity that his
trust be absolute, because without treatment Elyse will die by morning.
Ed falters, and House orders the treatment. Chase and Foreman start her
on melarsoprol, which requires glass syringes and special IV tubing.
Foreman reads a list of potential side effects from the package insert,
which include vomiting, abdominal pain, blood toxicity, neural damage,
and cardiac arrythmia. Chase descibes the drug as "arsenic mixed with
confesses to Cameron that if Elyse recovers, it means she cheated on
him, so part of him doesn't want her to recover. He asks Cameron
if that makes him a terrible person, She simply replies, "Yes" and
leaves, visibly distressed.
Later, Elyse takes a turn for the
worse. She develops a fever of 104, an echo shows global
hyperkinesis, and her blood pressure drops to 90 over 40. Chase gives
her dopamine, to no effect after ten minutes. When House tells Ed that
Elyse's condition is delincing, Ed goes to her bedside and begs her not
to die. To House's obvious surprise, Elyse begins to wake. Ed and
Elyse have a private conversation, after which Ed takes his bag and
walks out, leaving Elyse stricken and sobbing.
House asks Elyse
for the name of her lover, as he needs treatment as well. He asks why
she lied, knowing her life was at risk, but she doesn't answer. Cameron
is sent to notify Elyse's lover, who turns out to be Ed's friend and
Diagnosis: African trypanosomiasis
House thinks Wilson is fooling around on his wife because he is
wearing a new green tie and stylish French shoes. Lunch with oncology
thinks House is unusually critical of late. He becomes increasingly
irritated, and finally questions House about it. When Foreman has an
idea that House likes, House says, "That's why I ride you," which only irritates Foreman further.
herself to the possibility that either Ed or Elyse had an affair
because they appear to be utterly devoted to each other. Elyse told Cameron
that she had been trying to get pregnant, so House thought Cameron
might have emotional baggage (her aforementioned "damage") about babies
due to her near emotional collapse during the epidemic in the maternity
ward. He tells Cameron that he checked her medical records to see
if she'd ever been prescribed folic acid or if she had ever been
pregnant, to Cameron's great indignation.
After the incident
with Ed, House finds Cameron crying over a centrifuge. He asks
why she said what she did, and Cameron tells House of her short-lived
marriage. When she was in college, she married a man who died six
months later, of thyroid cancer which had metastasized to his brain.
House notes that he would have been diagnosed at least a year
before his death, so she knew he was going to die, but she married him
anyway. He tells her it's a symptom of her damage, not her actual
damage because "no one can be that good a person and well-adjusted."
Cameron chases after Ed as he leaves Elyse, telling him that he's lucky
his wife is alive, and that she loves him. Ed simply states that you
can't love someone and cheat, and leaves.
Elyse chose to risk death rather than reveal her infidelity.
Wilson evades House's questions about his spiffy appearance.
Ed's friend's kid
X-Ray tech, Radiology Room 3 (paged)