|First Appearance||Occam's Razor|
Brandon Merrell was the patient in the episode Occam's Razor.
Case Historyemergency room after he collapsed after having sex. His girlfriend noted that before he collapsed he was complaining of a cough and nausea and had a rash on his abdomen.
Dr. Wilson referred the case to Dr. House because the patient's blood pressure was low and did not rise when he was given intravenous fluids. The patient was suffering from fever, a cough, nausea, a rash, low blood pressure and abdominal pain. The patient's CPC was unremarkable and the abdominal CT scan did not show anything. Dr. Chase suggested an infection, but this would not explain the rash or cough. Dr. Foreman suggested arthritis and vasculitis, but this would not explain low blood pressure. Dr. Cameron suggested an allergy, but this would not explain the abdominal pain. Dr. Chase suggested a carcinoid. However, Dr. Cameron pointed out no condition would cause all the symptoms. Dr. House believed the blood pressure was the most pressing problem. He ordered antibiotics for sepsis along with a core stim test and an echocardiogram.
The patient's girlfriend admitted to Dr. Chase that they had engaged in rough sex before he collapsed, but Dr. Chase dismissed this as a cause for the patient's symptoms.
Dr. Foreman believed it might be a virus. He also noted from the patient's tests that the patient's blood pressure had fallen further, there was fluid in his lungs, and his creatinine was rising - indications of kidney failure.Dr. House added kidney failure to the list of symptoms, but Dr. Foreman viral heart infection was causing a lack of blood to the intestines, causing the pain. Although the presentation is very rare, it explained many of the symptoms except the cough and rash. Dr. House reviewed the previous differential diagnoses and circled the symptoms they cause. However, Dr. House noted a sinus infection combined with hypothyroidism would account for all the symptoms. He ordered the team to treat for both conditions and Dr. Cameron carried out the treatment. However, Dr. Foreman doubted that the patient had two independent conditions and went to test for viral infections. Dr. Cameron and Dr. Chase agreed to assist.
The virus tests turned out negative. Dr. House found the team in the lab and ordered them to spin the patient's urine. Dr. Foreman performed the test and discovered the kidney failure was the result of acute interstitial nephritis, which could not be caused by antibiotics. In addition, the patient was beginning to improve with treatment.
The patient was feeling better, but was still suffering from a cough. Foreman decided to test the patient's thyroid, but the TSH T3 and T4 were negative for hypothyroidism. Dr. House noted that given the patient's improvement the test could be wrong. Dr. Foreman argued that if it was a virus, the antibiotics for the sinus infection would affect the patient's liver and kidneys, leaving him unable to fight off a virus. Dr. House ordered a white blood cell count which, if it was normal, would rule out a virus.Colchicine, that suppresses the body's ability to duplicate cells, would account for each of the symptoms except the cough. However, if the patient was given colchicine by mistake when he was given a prescription for cough medicine, that would explain why the rest of the symptoms followed the cough. However, Dr. Cameron pointed out that he could not have gotten colchicine while he was in the hospital because they were monitoring everything he received and his condition improved before he got worse. However, Dr. House got the patient's mother to admit she gave the patient the cough medicine after he started to get better because he still had a sore throat and cough. However, all the pills were gone. Dr. Chase went to the original pharmacy, but the patient's mother confirmed that the pills provided by the pharmacist were identical to the pills the patient took - it was cough medicine.
Dr. House believed the cough medicine may have reacted with the patient's underlying condition. However, lymphoma had been ruled out. The only choice appeared to be exploratory surgery despite the patient's weakened condition. The team started to prepare the patient for surgery. However, he went into cardiac arrest during prep which meant the surgery had to be postponed even though the patient was restored to normal sinus rhythm.
Dr. Cameron reported to Dr. House that the patient now had pain in his fingers. She believed it was from an infection, but Dr. House noted that this would be the next symptom of colchicine poisoning. The next symptom is hair loss, and he was clearly starting to lose his hair. Dr. House got the patient to admit he took ecstacy, which could have been adulterated with colchine. Dr. House ordered FAB fragments for the colchine poisoning and Acetaminophen for the pain of having his hair pulled out. The patient improved rapidly with treatment.