TV’s fictional Dr. House helps diagnose heart failure patient

Doctors at a clinic in Germany report that the TV show House(also known as House, M.D.) provided them with an unexpected diagnosis for a heart failure patient.

Though the bedside manner of the misanthropic, Vicodin-addicted Dr. Gregory House may leave little to be desired, fans of the series this fictional character lends his name to thrill at his Sherlock Holmes-like powers of deduction.

House is a hospital drama where self-contained episodes are based less around the interpersonal entanglements of a show like ER, or the slapstick medical comedy of Scrubs, and the only bad guys are the diseases Dr. House himself diagnoses.

Given this premise, the writers of the show most likely trawled endless medical encyclopedias to come up with a supply of increasingly obscure diseases to keep Dr. House occupied across the show’s eight seasons.

Munchausen syndrome, frontal lobe disinhibition and “alien hand syndrome” are just a few of the medical nemeses House has faced. So comprehensive is the range of pathologies on the show, that Prof. Juergen R. Schaefer, director of the Center for Undiagnosed Diseases in Marburg, Germany, runs a medical class in which he teaches students to diagnose rare diseases using the TV show.

This class has led Dr. Schaefer to be known as “the German Dr. House” in the German media. But Shaefer’s unorthodox approach is no teaching gimmick. Indeed, Prof. Shaefer and his colleagues’ detailed knowledge of the show has had some surprising results.

‘The Marburg patient’

When a patient was referred to the Marburg University clinic in 2012 with severe heart failure, previous medical examinations had already ruled out the most likely cause -coronary artery disease. But despite going to the hospital several times over the course of a year with a range of symptoms, the patient’s doctors were not any closer to a clear diagnosis of what was causing the problems.

But when the patient arrived at Marburg University clinic, the symptoms he was presenting with – includinghypothyroidism, esophagitis, fever, increasing deafness and loss of sight, as well was heart failure – bore “striking similarities” to a case on the Marburg medics’ favorite medical TV show.

In that episode, Dr. House had diagnosed his patient with cobalt poisoning caused by debris from a metal hip replacement.

Examining their patient’s medical history, the medics indeed found that 2 years earlier he had undergone an operation to replace a broken ceramic hip prosthesis with a new, metal-on-plastic hip.

Cobalt intoxication

Blood tests revealed that there were severe levels of cobalt and chromium in the patient’s blood, and a radiograph confirmed that metal in the prosthetic had broken away, causing “cobalt intoxication.”

Though cobalt intoxication has been a well-known cause of cardiomyopathy (disease of the heart muscle) for 50 years, mostly it has only been recognized in steel workers exposed to cobalt as part of their day-to-day work.

Cobalt is used in hip replacements because it is a very stable compound. But in some cases where there have been technical problems with installing the prosthetic hip – or where a ceramic hip has been replaced with an “off-label” metal component, as with this patient – cobalt can enter the bloodstream and poison the patient.

In the conclusion of his study in The Lancet, Prof. Schaefer says that cobalt intoxication from faulty hip replacements is “a problem which appears to be on the increase, and which can be life-threatening.”

The episode of House featuring this diagnosis, “Family Practice,” was broadcast in February 2011, a few months before Medical News Today published a press release from the Medical Journal of Australia warning of the dangers of cobalt toxicity from metal-on-metal hip replacements.

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