According to specialists, if the cancer started at the base of his tongue (as Douglas’ press representative described), he probably has a type of cancer called oropharyngeal cancer.

Danger level: High

What is it?

Oropharyngeal cancer is a disease in which malignant cells form in the oropharynx.

Who gets it?

The average age of being diagnosed with oropharyngeal cancer is 60, with men getting it twice as frequently as women. It’s more common in African-Americans men than in white men.

There are certain things that raise your risk of getting oropharyngeal cancer (called risk factors). Such risk factors include:

1. Smoking and chewing tobacco
2. Heavy alcohol use
3. A diet low in fruits and vegetables
4. Drinking a sort of a South American stimulant drink named maté.
5. Chewing an Asian type of stimulant called betel quid.
6. Being infected with human papillomavirus (HPV) – This is a sexually transmitted virus. Unsafe oral sex with multiple partners is a risk factor for getting infected with HPV.

Michael Douglas said in his interview this week that he used to be a drinker and a smoker.

Alcohol and smoking are major risk factors for oropharyngeal cancer. Photo by Darwin Bell

What causes it?

First of all – what is the oropharynx, in which this cancer develops?

The oropharynx is the middle part of the throat (the throat is also called pharynx), behind the mouth. This part includes the back 1/3 of our tongue, the soft palate, the side and back walls of the throat, and the tonsils.

As with other types of cancer, oropharyngeal cancer happens when cells in this area start to grow out of control, for reasons not clearly understood.

How does it feel?

People with oropharyngeal cancer may feel any of those:

1. A sore throat that doesn’t go away – Michael Douglas’ tumor was discovered due to this very complaint.
2. A lump in the back of the mouth, throat, or neck
3. A dull pain behind the breastbone
4. Cough
5. Trouble swallowing
6. Weight loss not caused by a diet
7. Ear pain
8. A voice change

How is it discovered?

Diagnosis is made by taking a sample of the area suspected to be cancerous and looking at it under a microscope. A CT scan or an MRI are also used, and can help to see if the cancer has spread.

During the diagnosis process, tests are done to find out if the cancer has spread from the oropharynx to other places in the body. This is part of the staging process, common in cancers. Staging tells which stage the tumor is at (there are 4 stages), and can help guide the right type of therapy and also tell about the chances of survival.

Stage 1: In this stage, the cancer is 2 centimeters or smaller and is still in the oropharynx.

Stage 2: It’s between 2-4 centimeters, and is still in the oropharynx

Stage 3: It’s larger than 4 centimeters and is still in the oropharynx, or it has spread to a nearby lymph node.

Stage 4: It has spread further.

(This is a summary of stages, and lacks many details)

Michael Douglas’ tumor is at stage 4.

How is it treated?

Depending on the stage, oropharyngeal cancer can be treated by surgery, radiation therapy, and other types of possible treatments which include chemotherapy, among other things.

What happens after treatment?

That depends on the stage and the location of the tumor. The survival after treatment is better in earlier stages.

The bottom line – How do I avoid it?

1. Stop smoking – This is the most important thing you can do.

2. Limit your alcohol consumption

3. Limit the number of your sex partners. Using a condom, unfortunately, can’t fully protect you from HPV during sex.

Here’s the part of the interview with Michael Douglas, as seen on the David Letterman show:

Related posts:

1. Lung Cancer – Why You May Be at Risk (As Seen on House MD)
2. In The News – Pancreatic Cancer – The 4th Leading Cause of Death
3. Pleural Mesothelioma – Cancer of The Lungs Caused by Exposure to Asbestos

Click here to read the connection to the episode (spoiler alert!)


On episode 20 of season 1 (called “Love Hurts”)  a guy named Harvey Park comes to the clinic and suffers a stroke after House yells at him. His CT scan shows death of brain tissue. Deciding the stroke (which caused the brain death) was due to a blood clot, the team start to make assumptions as to where that clot came from . Turns out it came from an infection in his jaw, called osteomyelitis. Infected tissue from the jaw broke off, clogged an artery, and thereby blocked blood supply to the brain.

Danger level: High

What is it?

Osteomyelitis (OM) is an infection of the bone.

Who gets it?

Osteomyelitis isn’t very common: it happens to about 2 out of every 10,000 people.

It occurs mostly in young children and older adults, but it can affect anyone.

Osteomyelitis is an infection of bone. Photo by an untrained eye.

It’s more likely to occur in these people:

1. People with diabetes, sickle cell disease, HIV or AIDS, Rheumatoid arhritis

2. People who abuse alcohol or IV drugs

3. People who use steroids for a long time

4. People who are after a severe bone fracture or bone surgery

What causes it?

When a bone becomes infected, its inner part (the bone marrow) becomes swollen and presses against the rigid outer wall of the bone. That also presses the blood vessels in the bone, cutting the blood supply to the bone. Without it, bone simply dies.

The dead bone (called sequestra) is difficult for the body to cure, since its protective cells usually use the blood to reach places of infection.

How does it feel?

Acute osteomyelitis (acute because it can also become a long term condition, called chronic osteomyelitis) develops rapidly over a period of 7-10 days. Symptoms include:

• Fever, fatigue, irritability
• Nausea
• Tenderness, swelling, warmth and redness around the area of infection
• Lost range of motion of the involved extremity

If it happens in the vertebrae it can cause back pain.

How is it discovered?

On X-ray changes typical for osteomyelitis may show, but it may take them a few weeks to show up. CT and MRI can also be used, but they can’t make the diagnosis since what you see there may be seen in other types of bone problems.

An image showing osteomyellitis in the vertebral column. Photo by Nuclear Fire

Bone scans (images of bone taken after injecting a radioactive substance into the body) will almost always show a problem.

The doctor may take a sample of blood, pus, joint fluid, or the bone itself to diagnose infection to the bone and the germs causing it.

How is it treated?

Antibiotics are usually used to treat OM. Depending on the severity of the infection, they may be given directly to the vein at first but can be given by mouth later. Usually treatment takes weeks (between 4-8).

Sometimes surgery is needed to clear the infected area.

What happens after treatment?

With early and proper treatment, the condition usually goes away. There can be complications, though, such as an abscess (like the one on the House episode, causing the foul breath in the patient).

In some cases, the disease can spread to a nearby joint, causing an infection in the joint. If OM happens in children, it may impair their growth afterwards. The condition may also lead to skin cancer in the area of the infection.

People with artificial joints or metal components attached to a bone should take preventive antibiotics before surgery since they may be at increased risk of infection from bacteria normally present in the mouth and other parts of the body (In the House episode the patient had an artificial jaw that got infected).

Related posts:

1. Echoviruses (As Seen on House MD)
2. Subacute Sclerosing Panencephalitis (As Seen on House MD)
3. Sleeping Sickness – A Fly Bite That Ends in A Coma (As Seen on House MD)

On episode 19 of season 1, called “Kids”, a young diver named Mary arrives at the hospital during a meningitis scare, but her symptoms don’t fit those of meningitis. What she does have is neck pain which only happens when she twists her neck side to side, and a sort of rash on her lower abdomen.

Photo by Fox.

Later internal bleeding and seizures caused by brain bleeding are added to the symptoms. The final straw comes when it’s found out she’s also pregnant. Combining it all together, her pregnancy has caused a disease called thrombotic thrombocytopenic purpura which explains all of her symptoms.

What we usually do here as part of the House MD Project is tell you what happened in the episode and then explain the disease. This time, the disease was already covered here on A Disease A Day (it was actually the first ever article written on the site). You can read about it in the following link:

TTP – Thrombotic Thrombocytopenic Purpura – A Rare Disease That Could Kill You

Related posts:

1. TTP – Thrombotic Thrombocytopenic Purpura – A Rare Disease That Could Kill You
2. Echoviruses (As Seen on House MD)
3. Colchicine Overdose (As Seen on House MD)

Click here to read the connection to the episode (spoiler alert!)


On episode 18, called “Babies & Bathwater”, a young pregnant woman named Naomi is having brain and kidney dysfunction. An x-ray shows a mass in her lung, which turns out to be a type of lung cancer, called small cell lung cancer. The problems she had with her kidney and brain are related to a phenomenon called paraneoplastic syndrome, which often comes with that type of lung cancer.

Photo by Fox.

Danger level: High

What is it?

Lung cancer is a disease in which malignant cells form in the lung.

Who gets it?

Lung cancer is second most common cancer in the US, second only to prostate cancer in men and breast cancer in women. (Throughout the world it’s number 1 in men, and number 5 in women). It’s the leading cause of cancer death in the US.

Lung cancer is twice as common in men than in women. The chances of having it grow as you age.

People who smoke have the greatest risk of developing lung cancer (at least 4 out of 5 cases are associated with cigarette smoking). The risk of lung cancer increases with the number of cigarettes you smoke per day and the number of years you have smoked. About 10% of all smokers eventually develop lung cancer.

There are other risk factors related to developing lung cancer:

1. Exposure to secondhand smoke: Even if you don’t smoke yourself and only exposed to other people’s smoking your risk is higher.
2. Exposure to radon gas in the home: It hasn’t been completely proven, but some studies suggest there’s a relation between this and lung cancer.
3. Exposure to carcinogens: A carcinogen is a substance that’s involved in cancer formation. Examples include asbestos, radiation, arsenic, chromates, nickel, and others.

Smoking is the most proven risk factor for lung cancer. Photo by Helga Weber

What causes it?

The exact mechanism isn’t known. What is known is that there are several types of lung cancer, broadly divided into 2 categories: Small cell lung cancer (the one featured on the House episode) and Non-small cell lung cancer.

These names have been given because of the way the cancer looks under the microscope. But their separation means more than that: Small cell lung cancer is much more aggressive. It spreads quickly, making it particularly threatening. Up to 75% of people diagnosed with this type have a metastatic disease (cancer that has spread) by the time they are diagnosed.

Large cell lung cancer divides into further 3 types, but this is beyond the scope of this article.

How does it feel?

That depends on the type of lung cancer, where the cancer is, and the way it spreads.

One common symptom is a chronic cough. Some people cough up blood or sputum streaked with blood. Other things which may appear include loss of appetite, weight loss, fatigue, chest pain, and weakness.

Lung cancer can also cause all sorts of complications:

1. It can block the airways: This can lead to anything from wheezing, to a collapse of the lungs, to pneumonia.
2. It can cause a “pleural effusion” – that’s fluid that accumulates around your lungs.
3. It can cause something called Horner’s syndrome: Which is a condition in which you have a droopy eyelid, a small pupil, and reduced respiration on one side of the face. This can happen if the tumor hits a nerve on its surroundings.
4. It can cause paraneoplastic syndromes: This is the phenomenon shown on the House episode. These are things caused by the cancer at places far from the cancer itself
5. It can spread to other parts of the body through the bloodstream: areas it tends to spread to include the liver, brain, adrenal glands, spinal cord, or bones.

That’s a partial list. If not treated, it can also lead to death.

How is it discovered?

The first thing done is usually a chest X-ray. A CT scan will show the tumor with more detail, and also discover tumors that an X-ray may have missed.

A biopsy (a piece of the lung taken for examination under a microscope) is usually needed to confirm the diagnosis.

How is it treated?

There are various ways to treat lung cancers. They depend on the type of cancer, its location, its severity, whether it has spread, and the person’s overall health.

Treatments include surgery, chemotherapy and radiation therapy.

What happens after treatment?

Lung cancer isn’t good news, even when treated. On average, people with non-small cell cancer who aren’t treated survive 6 months. Treated, 70% of them may get well and live after 5 years. With small cell lung cancer, less than 1% will live after 5 years.

• Don’t smoke! Also, quitting smoking can lower your chances of developing lung cancer considerably.
• If you live or work with smokers, encourage them to quit and ask them not to smoke around you.
• If you’re exposed to cancer-causing chemicals at work, take necessary safety measures to limit inhalation.

Related posts:

1. Following Michael Douglas – Oropharyngeal Cancer – What Is It and How Can You Protect Yourself?
2. Pleural Mesothelioma – Cancer of The Lungs Caused by Exposure to Asbestos
3. In The News – Pancreatic Cancer – The 4th Leading Cause of Death

Click here to read the connection to the episode (spoiler alert!)


On episode 17 of season 1, named "Role Model", an African American presidential candidate vomits and passes out. Tests show he has problems with his immune system, because he has a brain infection with something called toxoplasma as well as fungal infections. After ruling out AIDS as the cause for his immune deficiency House finds out he took an epilepsy drug (phenytoin) as a child. Combining that drug with an EBV infection can lead to a condition called Common Variable Immunodeficiency (CVID), which caused his immune deficiency.

photo by Fox

Danger level: High

What is it?

Common variable immunodeficiency (CVID) is a condition that damages the immune system – the system in our body responsible for fighting off infections.

Who gets it?

The condition is quite rare. It happens to 1 out of every 50,000 people. It can become evident anytime from infancy to ages 20-40 (but for more than 2/3 of people it happens after age 21).

In some cases, the condition is hereditary.

What causes it?

Our immune system is composed of many types of cells. The function of these cells is to ward off intruders (like bacteria and viruses). One of these types of cells is called B cells. These cells produce special proteins called antibodies. These attach to foreign particles and germs, marking them for destruction.

A type of B cell, as shown under a microscope.

In CVID there’s a mutation in the gene responsible the development and function of B cells. This causes B cells to be defective – they can’t make enough functional antibodies.

The lack of antibodies makes it tough for people with the disorder to fight off infections. Also, vaccines don’t work in these people.

How does it feel?

People with CVID can develop recurrent infections in their lungs, sinuses, or ears.

Over time, recurrent lung infections can lead to chronic lung diseases and life-threatening breathing problems.

These people can also have infections and inflammation in their gastrointestinal tract, leading to bloating, diarrhea, decreased absorption of nutrients, and weight loss.

About 20% of people with CVID also develop autoimmune diseases – these occur when the immune system attacks the body instead of intruders. They are also at higher risk of developing cancer.

This video shows the example of Adam Brock, a 14 year old with the condition:

How is it discovered?

It can be discovered by a blood test, which will show low levels of antibodies in the blood.

How is it treated?

Treatment consists of injecting antibodies from donors into the blood of the person with the disease (watch the video above to see how this happens). This isn’t a cure and needs to be repeated over and over again.

The bottom line – How do I avoid it?

If the condition runs in your family, a genetic counseling before pregnancy may help prevent the birth of a child with the condition.

When you do have the disease, receiving the antibody treatment can help avoid the recurrent infections.

Related posts:

1. AIDS (acquired immunodeficiency syndrome) – All You Need To Know
2. Iron Deficiency Anemia – A Common Type of Anemia
3. Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency – When Certain Conditions Can Destroy Blood Cells

Click here to read the connection to the episode (spoiler alert!)


On Episode 16 of Season 1, called Heavy, a 10 year-old obese girl named Jessica is admitted to the hospital after having a heart attack. She later has low blood sugar, and after a few misdiagnoses and treatments starts bleeding from skin necrosis, which the team think is related to one of the treatments. Not a minute too late, House diagnoses her with Cushing’s syndrome due to a tumor in her brain.

Danger level: Medium

What is it?

Cushing’s syndrome is a condition in which there is too much of the hormone cortisol in the body.

Who gets it?

Cushing’s syndrome isn’t very common, and happens to about 13 out of every million people each year.

What causes it?

Cortisol is a steroid hormone produced in our body. It’s released in response to stress or when its level in the blood is low. Its function in our body is to raise blood sugar, suppress the immune system and help with the body’s metabolism.

To understand why Cushing’s syndrome happens, you first have to understand how our body releases and handles cortisol.

The brain makes a hormone called CRH, which tells a gland under the brain, called the pituitary gland, to make another hormone called ACTH. ACTH causes our adrenal glands (which sit above our kidneys) to produce cortisol.

Now what causes cushing’s syndrome?

1. Taking steroid medicine – These aren’t the steroids you may know that athletes take. Steroids are types of drugs used to suppress our immune system and that are given in diseases such as lupus, asthma, and rheumatoid arthritis. Taking these for a long time is the most common cause of Cushing’s syndrome.
2. Tumors on the pituitary gland – Like the case on the House episode. This is the second most common cause, and has a slightly different name: Cushing disease. This isn’t cancer and doesn’t spread like cancer does. What this tumor does is produce extra amounts of ACTH which cause the adrenal gland to produce more cortisol than it should.
3. Tumors on the adrenal gland – These can sometimes be cancer. These tumors produce extra amounts of cortisol themselves.
4. Tumors elsewhere – These can be lung tumors and others, that simply produce ACTH, causing the adrenal gland to produce extra cortisol.

How does it feel?

• The most common symptom is weight gain, especially around the waist, and around the upper back (something called a buffalo hump). It also caused a rounding of the face called moon face.
• Fatigue
• Muscle weakness
• Flushing of the face
• Skin changes: The skin bruises easily. You get acne. You get pink or purple stretch marks (called striae) on the belly skin, thighs, breasts, and arms.
• Slow healing of wounds and infections
• Mood changes, such as depression, anxiety and irritability.
• Thicker or more visible body and facial hair.
• Irregular or absent periods in women.
• Diabetes
• High blood pressure
• Bone loss, which can lead to fractures

And more…

This video from The National Geographic shows an excellent example and explains it:

www.youtube.com/watch?v=vxSAhLyKVqw

How is it discovered?

There are blood tests that can find out if you have Cushing’s syndrome. Once these are done, a CT scan of your adrenal and an MRI of the pituitary gland are done to find a possible tumor.

Other tests may be possible, which are beyond the scope of this article.

How is it treated?

If the condition is caused by steroid medicine, your doctor will lower your dose or stop them altogether. You should never stop taking steroids on your own, as that can be dangerous to your health.

If a tumor is causing it, it can be removed in surgery, or by other means.

What happens after treatment?

If the surgery removes the tumor completely, people may be cured, although it can sometimes return.

The bottom line – How do I avoid it?

If you take steroids, awareness of the signs of the condition can help you avoid its continuation down the road.

Related posts:

1. Turner Syndrome – The Missing X
2. Carcinoid Tumors – A Rare Tumor Often Not Found On Time
3. Hashimoto’s Thyroiditis – Do You Suffer From Weight Gain, Fatigue or Hair Loss? This Might Just Be The Cause

Click here to read the connection to the episode (spoiler alert!)


On episode 15 of season 1, called Mob Rules, a mobster named Joey arrives at the hospital with a coma, from which he comes in and out to repeatedly. It turns out Joey has ornithine transcarbamylase deficiency, a disease causing him to not being able to digest red meat. On a side note the team also discover he has hepatitis C (an infection transferred either by needle sharing or homosexual activity) and that he has a high estrogen level in his blood, caused from a drug used to suppress libido. The last two facts lead house to the conclusion that he is also gay.

Danger level: High

What is it?

Ornithine transcarbamylase deficiency (OTD) is a rare genetic disorder causing a problem with eating protein.

Who gets it?

OTD is a rare condition – it affects about 1 in every 80,000 people. The condition is genetic, meaning it is passed on in families. It also usually happens to males, due to the mode it is inherited.

Usually the condition becomes apparent in the first few days of life. Sometimes, though (like in the House episode), the condition can manifest later in life.

What causes it?

We live and function thanks to millions of reactions that happen in our body each day. One of those reactions happen inside a cycle of reactions called the urea cycle.

The urea cycle. Drawing by Yikrazuul

The urea cycle is a sequence of reactions that happen in our liver cells. It processes excess nitrogen, which is generated when our body uses protein. In order to get rid of the excess nitrogen, the cycle turns it into urea, which the kidneys can get rid of in our urine.

Each of the steps in the cycle happens through the action of a special machine, called an enzyme. In OTD, one of those enzymes is damaged or missing. Since the body can’t get rid of the excess nitrogen, it is accumulated in the body, turning into a dangerous substance called ammonia.

Ammonia is dangerous for our nervous system and so the condition causes neurological problems. The excess can also damage the liver.

How does it feel?

The condition, as we mentioned above, usually becomes evident in the first days of life. The baby will be lacking energy, vomit, or refuse to eat. Its breathing rate and body temperature will be poorly controlled. Sometimes seizures can occur, and even a coma is possible.

In adults the symptoms aren’t very different. They can include loss of appetite, irritability, heavy or rapid breathing, weakness, vomiting, disorientation, sleepiness, and also coma and death. (Remember that the guy on the House episode had recurrent comas).

How is it discovered?

A blood test is done which shows that the person has too much ammonia in their blood. There’s also a test done on a urine sample that can give a clue to the condition.

Also, a genetic test can find out if the person has the defective gene (although it doesn’t work all the time).

How is it treated?

Since the body can’t handle large amounts of nitrogen (it can’t turn it into urea like it normally should), the treatment includes measures that lower the amount of nitrogen in the body.

This includes not eating lots of nitrogen (protein is very nitrogen-rich. That is why a low-protein diet is subscribed. Remember the mobster in the House episode couldn’t eat steaks?).

Treatment includes saying goodbye to steaks. Photo by FotoosVanRobin

Treatment also includes lots of food and water when a person is ill (since otherwise the body tends to break down its own protein at these times) and some medications that can lower the nitrogen in the body.

What happens after treatment?

The baby’s brain can be damaged from the disease (by the ammonia) if not treated on time. It’s important to catch the disease on time, and then to keep with the strict diet throughout life.

The bottom line – How do I avoid it?

As with other inherited diseases, you can’t really prevent it once the person is born with a defective gene. Parents that know they carry the defective gene and can transfer it to their children can use genetic testing to test if the developing embryo has the defective gene (a process called preimplantation genetic diagnosis).

Related posts:

1. Common Variable Immunodeficiency (CVID)–When a Cold Can Threaten Your Life (As Seen on House MD)
2. Allergies: All You Wanted to Know (As Seen on House MD)
3. Echoviruses (As Seen on House MD)

Click here to read the connection to the episode (spoiler alert!)


On episode 14 of season 1, named Control, a young ambitious CEO named Carly presents to the hospital with severe leg pain. During her hospital stay it is found that she also has heart failure. After the usual series of misdiagnoses House arrives at the conclusion that she has been abusing a drug called ipecac, used to induce vomiting, since she has bulimia nervosa. The ipecac syrup caused the damage to her heart, and probably also the damage to her leg’s muscles.

Photo by Fox.

What is it?

Bulimia nervosa (BN) is an eating disorder in which people eat a large amount of food in a short time and then get rid of the food they just ate.

Who gets it?

Like other eating disorders, mostly women (there are probably 10 times more women with the condition than men). It usually starts in teenage years or early twenties.

It is believed that in the US about 1-3% of women of high school or college age have the condition.

What causes it?

As with other mental illnesses, the exact cause isn’t known. It may be a mix of a few elements -

• Society – The modern Western world gives more and more importance to body image. Magazines and TV shows are scattered with images of thin individuals. Some people tend to equate thinness with success and worthiness. Add to that pressure from friends and the surroundings.
  
  A mannequin. With display windows showing such slim bodies, many women feel overweight. Photo by The Life of Bryan
• Emotional health – People with eating disorders may have psychological problems contributing to the condition, such as low self esteem, perfectionism (like the woman on the House episode), impulsiveness, family or relationship conflicts, and so on.
• Biology – It turns out there are genetics involved. If you have siblings or parents with the condition you may be more likely to develop it yourself.
• Occupation – If you have a job or do a sport that give an importance to body size, such as ballet, modeling, or gymnastics, you may be more likely to develop bulimia (other things considered…).

How does it feel?

People with bulimia repeatedly eat in binges – this means they eat large amounts of food within a short time. They tend to do it secretly. The food tends to contain high calories, such as ice cream and cake, and can sometimes reach thousands of calories. They may eat such large quantities that their stomach and esophagus may be damaged or torn in the process.

After eating comes the purging phase, in which they get rid of what they just ate. Ways of doing that include vomiting on purpose, taking laxatives (like the woman on the House episode), doing hard diets or fasting, over-exercising, or any combination of the above.

The vomiting can erode our teeth, since vomit includes acid. It can also enlarge our salivary glands and cause damage to the esophagus. It can change the level of salts in our body, putting the body in risk of abnormal heart rhythms and sudden death.

And, as was seen on the House episode, laxatives such as ipecac are dangerous to the heart.

This video tells the story of Sarah Siskin, who died of bulimia:

www.youtube.com/watch?v=yHZesejU6tU

How is it discovered?

When the doctor sees a person in the right age (and gender) that expresses concern about gaining weight combined with weight fluctuations, signs of laxative use, and other signs (such as scars on the knuckles from inducing vomiting, swollen salivary glands, etc.) their suspicion rises.

The only way to be sure of the diagnosis is by having the patient tell, which doesn’t always happen.

How is it treated?

There are 2 ways to treat bulimia:

Psychological: A therapy called cognitive-behavioral therapy is usually used, in which the wrong thoughts that led to the behavior are faced with, and people are helped to give them up.

Medication: A type of antidepressant drug is given and may help.

What happens after treatment?

There’s no sure path. With some people the disease may be related to life crises and pass when they do. For others, it may be fluctuating over many years. That also depends on how compliant the person is with their treatment.

Related posts:

1. Naphthalene Poisoning – When Mothballs Kill More Than Just Moths (As Seen on House MD)
2. Ornithine Transcarbamylase Deficiency– What If You Couldn’t Eat Steaks? (As Seen on House MD)
3. Neurocysticercosis – The Worm That Attacks Your Brain (As Seen on House MD)

Click here to read the connection to the episode (spoiler alert!)


On episode 13 of season 1, called cursed, a 12 year old boy named Gabe appears with a rash and pneumonia. After the team arrive at the conclusion he has anthrax and start treating him, skin lesions start appearing all over his body. Later on his arm gets paralyzed. After learning that the boy’s father has problems with the nerves in his hand and that he has been to India, House diagnoses Gabe with leprosy. (As you’ll learn ahead, leprosy doesn’t explain all of the symptoms the boy had. Once he was treated for leprosy (the treatment for anthrax works here too), his body caused a reaction which triggered the rest of the symptoms).

What is it?

Leprosy, also known as Hansen’s disease, is a chronic infectious disease caused by a bacteria. It affect the skin, eyes and nerves.

Who gets it?

That depends on where you’re from. Most cases of leprosy today happen in developing countries, mostly India and Brazil, although with travel it can happen anywhere.

In the US there are about 6,000 people with the disease, and about 95% of them got it abroad. About 200-300 new cases are reported each year, especially in states with large immigrant populations (such as California, New York and Florida).

Around the world about 2-3 million people are estimated to have the disease. About 86% of people with the disease live in one of 11 countries: Bangladesh, Brazil, China, Congo, Ethiopia, India, Indonesia, Nepal, Nigeria, Philippines, and Tanzania.

Leprosy around the world. Pink areas have the greatest amount of leprosy patients, followed by red, orange and yellow. In green areas the disease is rare.

There are a few risk factors – things that can put you at risk of getting infected:

1. Close contact – If you’re in contact with someone sick with leprosy.
2. Age – You’re more likely to get it if you’re older (and perhaps also if you’re between the ages 5-15).
3. Problems with the body’s defense systems – Most people will not develop the disease if they’re exposed to someone ill. Even if they do, they may develop a very mild form of the disease that heals by itself.
   Those who do develop the disease do so because a genetic defect in their body’s normal response, which should normally fight the bacteria.

What causes it?

Leprosy is caused by a germ called Mycobacterium leprae. It is spread by sick people through droplets from their nose and mouth, much like the common cold or the flu. Unlike them, though, it is not very contagious.

Mycobacterium leprae under a microscope. The germs are the red stuff scattered all over the picture.

Usually after we get infected with a germ, it takes time for it to grow, multiply and cause a disease. That time can take a few days with a cold. With leprosy, on the other hand, that time can be very long, and takes between 6 months and 40 years (!).

The leprae germ likes cool places in the body, so its best tourism sites are our superficial nerves, skin, the linings of the inside of our upper airways, the eyes, and the testicles. There they cause damage.

How does it feel?

Since, as mentioned above, it takes the bacteria a long time to multiply, the symptoms usually don’t appear before 1 year after infection (usually 5-7 years).

Skin – The disease causes characteristic rashes to appear. They can be a few flat, whitish areas which are numb to touch, in the milder form of the disease (called tuberculoid leprosy). In the more severe form of the disease (called lepromatous leprosy) there are many small bumps or large raised rashes of many sizes and shapes. There are also more areas of numbness and even weak muscles. It can also affect other areas in the body, such as our nose, kidneys, and testicles.

There can also be swellings and lumps on the skin.

Nerves – The sense of touch deteriorates so that the person can’t feel pain and temperature changes. These people may get burns or cuts and don’t notice it. This may lead to loss of toes or fingers. The damage to the nerves can also cause muscle deformation (causing things like clawed fingers).

These are the main symptoms, although there are more.

You can see some visuals of how this affects the body here. Be warned, though, that these aren’t easy pictures to look at.

How is it discovered?

The symptoms (such as the rash) give the doctor a clue. Doing a biopsy of infected skin (which means cutting a small sample and looking at it under a microscope) confirms the suspicion.

How is it treated?

Antibiotics are the treatment for leprosy. They can’t reverse the damage, but can stop any new damage from happening.

The leprosy bacteria are hard to kill and so treatment may continue for a long time – anywhere between 6 months of treatment to many years (and even a lifelong treatment in some cases).

What happens after treatment?

That depends on the type of disease (tuberculoid vs. lepromatous) – the more severe the form of the disease, the less chance there is for a cure. After cure, the disease may (rarely) return, which will require another treatment.

As we said above, leprosy isn’t very contagious. Only the lepromatous form of the disease, if untreated, is contagious (even then, not as much as other infections). Once treatment has begun, the disease is no longer contagious.

To avoid getting infected, avoid contact with bodily fluids and the rash of infected people. Sometimes the vaccine against tuberculosis may protect you against leprosy, but it’s not used very often.

Related posts:

1. Lyme Disease – The Little Bugger That Could
2. Sleeping Sickness – A Fly Bite That Ends in A Coma (As Seen on House MD)
3. Echoviruses (As Seen on House MD)

Click here to read the connection to the episode (spoiler alert!)


On episode 12 of season 1, called sports medicine, Hank Wiggen, a baseball star, suddenly breaks his arm due to an unexplained bone loss. Add to that shrunken testicles and a kidney failure. His wife also hasn’t been able to smell anything for six months. Their combined symptoms lead to the diagnosis of cadmium poisoning.

Danger level: High

What is it?

Cadmium is a chemical element (remember your periodic table of chemical elements? its name there is Cd). It has no function in our body and is toxic, even in low amounts.

Who gets it?

Exposure to cadmium can occur in the workplace or outside of it. In the workplace it can be encountered in battery manufacturing plants, in iron and steel production, and in many other occupations.

Outside the workplace, cadmium can be found in the air, water or soil, especially in industrial areas. It may also be found in certain foods, such as kidneys and livers of adult animals and in certain seafoods, such as mussels, oysters and crabs. And lastly, it can be found in small amounts in tobacco (another reason to quit smoking).

In Japan many people have consumed rice that was grown in cadmium contaminated irrigation water, causing a toxicity they called itai-itai disease (simply translated to “ouch ouch sickness”).

Cadmium can be found in air, water or soil. In fact, on the House episode, the source was the soil in which marijuana the couple consumed grew. Photo by john.duffell

This video is from January this year, when cadmium was found in metal toys, which were eventually pulled off the shelves:

www.youtube.com/watch?v=vvcfTtg1WXY

How does it feel?

One of the symptoms of cadmium exposure is something called osteopenia, or loss of calcium from bones, making them weak and brittle. Osteopenia is a usual phenomenon when we get old. When it happens prematurely, something is wrong…

The osteopenia causes spinal pain and bone pain. The bones get deformed, affecting the way the person walks. Fractures can also happen easily.

Other symptoms include kidney failure, pulmonary problems, loss of the sense of smell, and even cancer.

How is it discovered?

The most useful test for exposure to cadmium (as seen on the House episode) is a urine check, in which cadmium levels will be high. A molecule called β₂-microglobulin will be high in the urine as well. A blood test for cadmium can also discover it.

How is it treated?

There really is no effective treatment. The person exposed to cadmium should stop the exposure before irreversible damage happens to their kidneys.

If the bones are brittle, calcium and vitamin D can be used to try and strengthen them.

There are a number of steps you can take to avoid cadmium poisoning:

1. Quit smoking!
2. Identify potential sources of cadmium around your home, at work, and where your children play.
3. If you have a vegetable garden, use fertilizers tested for cadmium.
4. Properly store and dispose of cadmium-containing products (such as batteries, metals, fungicides, fertilizers, etc.).
5. Keep nickel-cadmium batteries out of the reach of small children and dispose of them properly.

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Related posts:

1. Naphthalene Poisoning – When Mothballs Kill More Than Just Moths (As Seen on House MD)
2. Organophosphate Poisoning – Getting Poisoned by Pesticides (As Seen on House MD)
3. TTP Explained Again (As Seen on House MD)