Also known as: Copper accumulation disorder
The central diagnosis of the episode. Lucy Palmero presents with psychiatric symptoms initially misdiagnosed as schizophrenia for 18 months. House discovers she actually has Wilson's disease, a genetic disorder causing copper accumulation in the body, which explains her psychiatric symptoms, liver cirrhosis, and cataracts (Kayser-Fleischer rings). The diagnosis resolves the entire case.
Also known as: Liver cancer
Lucy has a large liver tumor (5.8cm) discovered on ultrasound. House shrinks it temporarily using ethanol injection to 4.6cm to make it surgically resectable. The tumor is successfully removed and she requires chemotherapy. The tumor was likely caused by underlying Wilson's disease causing cirrhosis.
Also known as: DVT
The presenting symptom that initiates the case. Lucy develops a deep vein thrombosis in her calf, which is unusual for a 38-year-old with no risk factors. This prompts House's investigation. The DVT is eventually explained by vitamin K deficiency from malnutrition combined with Wilson's disease.
Also known as: Blood clot in lung
A piece of the DVT breaks off and travels to Lucy's lungs, blocking oxygen flow and causing respiratory arrest in the field. She is intubated and brought to the hospital. This complication of the DVT brings her into the hospital's care.
Lucy's diet consists entirely of cheeseburgers, which lack vitamin K. This deficiency causes both clotting problems (DVT through protein C dysfunction) and bleeding problems (prolonged PT time, significant hemorrhage requiring transfusion). The team discovers this by visiting her home and finding only fast food.
Also known as: Liver scarring
Lucy has mild cirrhosis of the liver, initially attributed to alcohol use but actually caused by Wilson's disease. The cirrhosis contributes to her bleeding complications and increases surgical risk. It's discovered on ultrasound examination.