Dr. House TV series saves patient life

Mysterious symptoms a patient properly recognized thanks to US television series

09/02/2014

While the information content of the television program generally leaves much to be desired, the television series has „Dr. House“ now proven to be a life-saving source of information. A doctor correctly recognized the mysterious symptoms of a 55-year-old patient, as they were seen in a similar episode of the US television series. About the case Jürgen R. Schäfer from the Philipps-University Marburg and colleagues in the renowned trade journal „The Lancet“ reported.

The patient was admitted to the Center for Unrecognized Diseases at the University Hospital Giessen and Marburg in May 2012 with a series of unexplained symptoms. He had heart failure, was almost deaf and almost blind, had fever of unknown cause, hypothyroidism (hypothyroidism), and reflux oesophagitis (due to gastric reflux due to gastric acid reflux). In addition, the patient suffered from a lymphadenopathy, especially in the area of ​​the left hip, write the doctors. „Finding the cause of this combination of symptoms got us hooked on an episode of the TV series Dr. House that we use for teaching medical students“, report Shepherd and colleagues. Thus, a cobalt poisoning was suspected as the most likely cause of the complaints.

Medical history of the patient was, according to the medical profession „mostly uneventful, except for the fact that both hips were replaced by prostheses.“ On the left hip in 2010, a broken prosthesis implanted in 2001 was replaced with a new implant. The doctors suspected a connection with the two years later occurring complaints of the patient, as they knew a similar case from the TV series. They then determined by radiography of the hip that the new prosthesis showed metal abrasion on the left hip. „The measurement of cobalt and chromium in the blood showed large increases in these metals“, write Prof. Schäfer and colleagues. The cobalt concentration in the blood sample has reached 15,000 nanomoles per liter (nmol / l), with normal values ​​below 15.3 nanomoles per liter. The detected chromium concentration was 942 nanomoles per liter (maximum 9.6 nmol / L are normal values).

Condition of the patient has stabilized quickly
After the cobalt poisoning caused by metal abrasion became the cause of the discomfort, the metal prosthesis was promptly replaced with a new ceramic hip prosthesis and the patient also received a so-called cardioverter-defibrillator (implant similar to a pacemaker) to compensate for the severe heart failure. Shortly after implanting the new prosthesis, cobalt and chromium concentrations in the patient's blood plasma already dropped, his condition stabilized, and he recovered quickly. Fourteen months after the procedure, in July 2013, a cobalt concentration of 1,460 nanomoles per Liter was measured (chromium 365 nmol / L). The heart function had improved significantly and there were no new fever episodes or signs of esophagitis. However, the hearing and vision of the patient hardly recovered. Nevertheless, the case shows that „Dr. House“ save lives not only on television but also in reality. (Fp)