House 105: Damned if you do

2008 August 10

by Jeffrey

This is a continuation of my series of medical reviews on the popular medical TV drama House M.D. A full list can be viewed under “House M.D. Reviews“.

In this episode of House, House’s new patient, Sister Augustine, has hands red with boils.

While her fellow nuns suspect stigmata, House suspects contact dermatitis brought on by an allergic reaction to dish soap. He gives her an antihistamine, suggests over-the-counter cortisone cream and sends the good Sister on her way. Unfortunately, the antihistamine leaves Sister Augustine gasping for air.House believes it is an asthma attack caused by an allergic reaction to the pill. He administer epinephrine, it restores her breathing, but unfortunately it knocks her into cardiac arrest. Sister Augustine is successfully resuscitated and admitted to the hospital. Some cool pictures on screen when House administers epinephrine; i have always liked the on-screen medical visualizations of the human body on the show.

this one is as House injects epinephrine into the patient..

Dr. Cuddy is certain that House made a mistake and maybe gave the nun the wrong dosage. Cuddy will have to notify hospital attorneys within 24 hours if House can’t find an underlying cause for the heart failure. He runs his team through possible explanations. Cameron suggests cellulitis, given that it can also manifest with tachycardia (the patient’s HR raced through the roof before she went into cardiac arrest). Could it be vasculitis? They order a chest CT and administer prednisolone 40mg tid.

The word cellulitis literally means inflammation of the cells. It generally indicates an acute spreading infection of the dermis and subcutaneous tissues resulting in pain, erythema, edema, and warmth.

Sister Augustine goes into CT, but inside the tube she becomes frantic about a smell (olfactory hallucination). The doctors cancel the test and Sister Augustine screams that Jesus is coming for her (religious visions). Suddenly, she suffers convulsions. Foreman notices a rash appear on the Sister’s leg as he’s holding her down:

He finds out that the nun tested positive for herpetic encephalitis which causes a weakened immune system. This same symptom can be triggered by the medicine House gave her earlier. The group tries to figure out other possible causes.

House then believes that the nun may have mixed connective tissue disease. The treatment for that disease is prednisone, which is what caused these problems in the first place. House recommends a hyperbaric oxygen chamber, but Foreman is concerned she might suffer from oxygen toxicity. Foreman goes to Cuddy and she becomes alarmed at the rash hyperbaric treatment. Cuddy pulls House off Sister Augustine’s case; the nun didn’t have elevated ANA levels!

Cuddy meets with Cameron, Foreman and Chase to discuss potential treatments. House, meanwhile, asks Chase if Sister Augustine is hiding something. Chase suggests talking to the Mother Superior, and House pays a visit to the convent. Mother Superior discusses Augustine’s troubled past as a foster child and the woman’s self-aborted pregnancy. That doesn’t interest House, but the tasty tea that the convent serves does.

It is figwort tea, which House claims when mixed with even the smallest level of epinephrine causes instant cardiac arrest. Based on a reader’s comment in Polite Dissent’s review of this episode:

Figwort tea is derived from the family of plants that is used to make the drug DIGITALIS.

Digitalis is a cardioactive steroid used to treat certain heart conditions. Digitals has several side effects including An irregular heartbeat that causes dizziness, the feeling that your heart has skipped a beat (palpitations), shortness of breath, sweating, or fainting.

It is in this way that mixing Figwort tea and epinephrine can cause a cardiac arrest.

House was correct all along. However, there is some allergy still lurking that has gone untreated for so long that it has manifested into a monster. House decides to introduce various allergens until one causes a reaction. Sister Augustine is placed into a hypoallergenic room but still goes into convulsions. The doctors are baffled. What in this sterile environment could make a person react so violently?

Sister Augustine decides that God wants to take her, so she requests to go back to the convent. House yells at her for constantly running away from her problems. Sister Augustine mentions that she has God inside her. She reveals her story about how she was on “every kind of contraception known to man” and
still got pregnant. I suppose this is some sort of 3D CT:

It is a copper cross IUD inside Sister Augustine’s uterus; she is allergic to copper, which also explains the initial dermatitis (caused by some recently donated copper pots and pans she had been washing.) Surgical extraction of the IUD allows the nun’s full recovery.

Other than that, drama wise, Cameron is shown to exhibit signs of infatuation with House, giving him a Christmas gift. House and Foreman begin their disdain for one another. And House and Wilson are shown celebrating Christmas with takeaway Chinese. The episode ends with Hugh Laurie (House) playing this piece of music “Silent Night” on the piano, which i thought was fantastic: