‘House’ episode clues in real doctor on cobalt poisoning

A German doctor saw a show that helped his team diagnose a patient’s mysterious illness.

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Hugh Laurie only plays a doctor on TV, but he has a following among physicians in Germany who are crediting his fictional Dr. House with helping them diagnose a man with a life-threatening case of cobalt intoxication.

The 55-year-old patient was referred to their clinic in Marburg in May 2012 suffering from severe heart failure. An echocardiogram revealed that his heart was pumping blood at about half to one-third of normal efficiency.

He also had extremely high levels of a hormone called brain natriuretic peptide, a hormone made by the heart.

A failing heart wasn’t the man’s only problem.

He had mysteriously become nearly deaf and nearly blind; his thyroid gland had slacked off; he had gastroesophogeal reflux; the lymph nodes near his left hip were enlarged; and he had a fever, according to a report published in Saturday’s edition of the medical journal Lancet.

The patient’s doctors were stumped, so they sent him to the clinic at Philipps University of Marburg, run by Dr. Juergen Schaefer, who is a fan of the “House” television show that starred Hugh Laurie as Dr. House, who pursues odd cases.

The medical team there noticed something significant from the patient’s medical history: In 2010, his ceramic artificial hip was replaced with a metal version.

This reminded them of an episode of “House” that they had screened for their medical students as a teaching case. In one of the story lines, the hospital administrator’s mother had a mysterious illness that caused her to faint and sent her heart rate through the roof.

Metal poisoning had been diagnosed and treated in the past, but Dr. House’s insight was to realize that the poisoning was ongoing — and that the source was an artificial metal hip.

The German doctors ordered a radiograph and found signs of metal debris near the real-life patient’s metal hip.

Blood tests showed concentrations of cobalt that were 1,000 times higher than normal and chromium levels that were 100 times higher than normal. Urine tests also found abnormally high levels of both metals.

The doctors initiated chelation treatment to remove the metals from his body. Then they sent him back to his orthopedic surgeons to have his metal hip replaced with a ceramic version.

It turned out that the spherical portion of the hip prosthesis had been “severely damaged,” according to the Lancet report.

After it was out, the patient began to improve and his ejection fraction rose to 40 percent. However, 14 months later he still had very high blood levels of cobalt and chromium, and his hearing and vision were still impaired.

As a consequence of his heart failure, the patient also got an implanted cardioverter-defibrillator to keep his heart rate steady.

In their Lancet report, the German doctors advised their colleagues to consider cobalt poisoning as a cause of heart failure in patients with metal hips.

Although cobalt intoxication has been known to cause cardiomyopathy for more than 50 years, it is usually considered a problem for people who are exposed to the metal in their jobs.

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