Gregory House, M.D. — the fictional character on the TV medical series House — is more than just a Vicodin-addict with slapstick humor who diagnoses obscure diseases; he even helps doctors solve real-life cases. Juergen R. Schaefer, director of the Center for Undiagnosed Diseases in Marburg, Germany, trusted his profound respect for House and used knowledge from the show to solve a medical mystery with his team. The detailed case, published in the journal Lancet, of a 55-year-old Marburg patient, unraveled just how exactly Season 7, Episode 11, led a heart failure patient to be accurately diagnosed with cobalt intoxication caused by a metal hip replacement.

Cobalt intoxication occurs when excessive levels of cobalt are present in the human body. High levels of the hard silvery-white magnetic metal can cause significant health problems, or even death in some cases. Swallowing, breathing, or having your skin constantly come into contact with cobalt are the three basic ways cobalt poisoning occurs. Although it is more prevalent in steel workers, recently, cobalt poisoning has been reported from the wear and tear of some metal-on-metal hip replacements, says Medline Plus. Cardiomyopathy, a problem where the heart becomes big and floppy and has trouble pumping blood, is a symptom of cobalt intoxication, and it is often confused for coronary artery disease.

Dr. House’s unorthodox approach to identifying rare medical conditions led him to diagnose a fictional patient with cobalt poisoning. Little did the show producers know this episode would aid German doctors to save a real-life heart failure patient years later. Schaefer, now known as “the German Dr. House,” saw the Marburg patient bore “striking similarities” to the patient in his favorite medical TV show, and so he decided to examine the patient's medical history.

Previously, the heart failure patient was in and out of hospitals, as doctors were not able to find a clear diagnosis for the cause of the patient's heart problems. Some of the symptoms included: hypothyroidism, esophagitis, fever, increasing deafness, and loss of sight, according to Medical News Today. After reviewing the patient’s medical history, the team of doctors found their patient underwent an operation to replace a broken ceramic hip implant with a new, metal-on-plastic hip. Blood tests showed the dangerously high levels of cobalt and chromium in his blood. In addition, a radiograph confirmed the tiny ceramic particles left from the first hip replacement led to the wear and tear. “You destroy the metal part with each movement,” Schaefer said.

The German doctors replaced the patient’s metal hip with another ceramic one, which led to a decrease in his cobalt level. Furthermore, the patient's heart function improved, although it was still necessary to get a defibrillator implanted. Fever and esophagus problems disappeared, but there was no improvement in the patient's hearing or eyesight.

This as-seen-on-TV study highlights cobalt intoxication is not just limited to so-called Quebec beer drinkers and steel workers; it can happen to those with hip replacements. In one of the first published studies on cobalt intoxication, doctors sought to find the cause of why a group of men —  heavy drinkers between their forties and sixties — died unexpectedly. The findings revealed all the men drank beer from a brewery in Quebec City, a brewery that added cobalt to stabilize the beer’s foam. Although cobalt was suspended throughout the world, a large number of patients died from the disease during the late 1960s, as the mortality rate reached 40 percent.

The obscure medical condition has gained a lot of traction over the recent years with an increase in cases from patients with hip replacements. This form of cobalt intoxication is "a problem which appears to be on the increase, and which can be life-threatening,” concluded the German researchers. Patients current of future hip replacements are advised to consult with their doctors about the chances of cobalt poisoning.

 

Sources:

Dahms K, Heitland P, Pankuweit S, Schaefer JR, Sharkova Y. Cobalt intoxication diagnosed with the help of Dr House. The Lancet. 2014.

Daniel P, Morin Y. Quebec Beer-Drinkers’ Cardiomyopathy: Etiological Considerations. Canadian Medical Association Journal. 1967.