House MD’s “It’s Not Lupus” Running Gag & The One Time It Really Was

Dr. Gregory House and his team dealt with several mysterious cases over the course of the show. Most of which were undiagnosed till the very end of the episode.

As a last resort, one of the characters would sometimes suggest the autoimmune disease lupus as the diagnosis because it was particularly difficult to detect, and it could be used as a possible explanation for the unusual symptoms they were seeing.

But every time, House’s response to the suggestion would be “it’s not lupus” and this began the ongoing gag of the patient’s illness never being lupus. That is, until it actually was in an episode of season 4.

In season 4, episode 8, it was finally lupus in House, M.D. A magician named Flynn suffers a heart attack while trying to do one of his tricks. But since he doesn’t have a heart disease, House does some tests and figures out that it was a lupus flare-up that affected his heart. 

The running gag that started 3 seasons ago finally paid off in this episode.

1. Why It’s Never Lupus

Lupus is a generally rare disease with symptoms that mimic the symptoms of other more common diseases. This makes lupus extremely challenging to diagnose and it’s natural for a misdiagnosis to happen as well.

In House, M.D. the character of Allison Cameron is usually the one to suggest lupus because she was a specialist in immunology.

Medical students are universally familiar with this disease and immunologists especially are trained to include it in a differential because it’s the most common serious autoimmune disease that they might see in a patient.

However, House tries to break her, as well as the other doctors under his fellowship, out of this habit because they needed to consider possibilities outside of their specialty.

House doesn’t think it’s wrong for his team to consider lupus as a diagnosis; he just believes that if a case were actually lupus, then it would have already been detected by a physician before being brought to his attention.

2. It’s Finally Lupus

In House, M.D. season 4’s episode titled “You Don’t Want to Know”, the doctors finally encounter an actual case of lupus.

In the episode, Flynn, a magician, suffers a heart attack and bleeding from the mouth while trying to perform a trick inside a water filled glass booth. However, every test he undergoes at the hospital shows no signs of any heart disease.

When Flynn gets a blood transfusion (an MRI mishap causes internal bleeding), he has an adverse reaction to the new blood because it’s the wrong type. House then figures out that the blood typing test went wrong because Flynn tested positive for antibodies he shouldn’t have had.

All the clues gathered lead House to believe that Flynn has lupus, to which he reacts by saying “it’s finally lupus!” The team is then able to explain Flynn’s heart attack as being caused by his lupus flaring up.

The lupus joke finally paid off; however, the episode was criticized for incorrect depiction of the medicine. For starters, the lupus was diagnosed through a fluke of treatment rather than through any obvious signs like malar rash.

Medical critic Polite Dissent pointed out that the medicine was artificial, and House’s explanation of blood mistyping and transfusion reactions was entirely wrong. This made it puzzling to understand how they came to the conclusion of lupus in the first place.

Overall, the episode was entertaining, especially the build-up to the lupus reveal. But considering that it’s a medical drama, it would have probably been a better idea if the writers did some more research about the condition and blood typing, before making a whole episode about it. 

3. About House

 House, M.D. is an American medical drama television series that originally ran on the Fox network for eight seasons, from November 16, 2004, to May 21, 2012.

The series’ main character is Dr. Gregory House, an unconventional, misanthropic medical genius who, despite his dependence on pain medication, leads a team of diagnosticians at the fictional Princeton–Plainsboro Teaching Hospital (PPTH) in New Jersey.  The series’ premise originated with Paul Attanasio, while David Shore, credited as the creator, was primarily responsible for the conception of the title character.

It was filmed mainly in a neighborhood and business district in Los Angeles County’s Westside called Century City. The show received high critical acclaim and was consistently one of the United States highest-rated series.