During a race, famous cyclist Jeff Hastert gasps for air and then collapses. At the hospital, Stacy rushes into House's office to remind him to renew his credentials. Cuddy interrupts with the details on Jeff. House asks Cuddy to fire Stacy for pestering him about paperwork. He's not interested Jeff's case because it's probably due to steroids. Yet he becomes intrigued when Cuddy notes that Jeff doesn't deny using performance-enhancing drugs.
Jeff lists for House the numerous ways medical science has given him an edge. On that list is blood doping. House and the team run through the symptoms. Jeff has tested normal for everything, and suffers from no clot or edema. Something is still causing respiratory distress. Foreman thinks an air bubble may have been caused by a poor injection. House asks for a VQ scan, which confirms that there is a bubble in Jeff's lungs.
Chase threads a Swan-Ganz catheter into a chest vein. He finds the bubble and begins sucking it out. Suddenly, Jeff starts to drool and the team searches for what is causing the muscle weakness. House calls for a muscle biopsy, which reveals Jeff tests negative for polymyositis, ALS and lupus. With the patient still suffering from muscle weakness, House wonders whether the normal results are actually substandard for an athlete like Jeff. Chase tosses out encephalitis, and House asks for a lumbar puncture to rule it out.
Foreman starts the puncture but Jeff's arms begin twitching. He gasps for air and lapses into respiratory arrest. Foreman intubates. The puncture comes back negative for encephalitis. House again wonders if wonders if Chase screwed up the embolectomy and pierced something. Either this could be why Jeff is losing blood or he's simply not producing enough. That acute anemia combined with a muscular disorder equals paraneoplastic syndrome or cancer.
Wilson performs a bone marrow biopsy. Jeff worries that something he took may have caused the cancer. Wilson hands Cameron a phone message, and he realizes that she called a newspaper to tip them off about Jeff cheating in the races. This has been weighing on her since he was admitted.
A chest x-ray shows that Jeff is negative for bleeds, and House declares that the patient has cancer. Wilson says that Jeff does not have cancer because he has pure red cell aplasia instead. This comes as a surprise to the doctors, since PRCA can't just suddenly manifest. Cameron thinks Jeff is lying about being on EPO.
As the doctors weigh their options, Cuddy and Stacy enter with news of the leak. Stacy will be sitting in with them until this is resolved. House wonders why somebody would leak a cancer diagnosis to make Jeff look bad. Then he realizes it's because he's on EPO. House barges into Jeff's room and tells him that acute PRCA is most commonly caused by EPO. Jeff still denies it.
House questions whether Jeff's ever-present manager was secretly injecting him. He considers checking her cell phone for the newspaper's number. The manager tells Jeff that a comeback from cancer will boost his image. Jeff instantly fires his manager.
That night, Foreman keeps a watch on the sleeping Jeff and he notices that something is wrong. The next morning, Foreman reports that Jeff's red blood cell count plummeted to 16 percent. The drugs should really be flushing out of his system by now. House posits that maybe Jeff wasn't using EPO.
Foreman mentions that he performed a transfusion and House is struck with an idea. He orders a CT scan on Jeff's neck, which reveals a thymoma. These are usually present in the chest. The team wants to know how House figured this out. House explains that they had scanned his chest so much, so it obviously wasn't there. Perhaps Jeff didn't have acute PRCA but had a chronic version instead. The constant blood doping served as the transfusions Jeff would need for such severe anemia.
House walks into Jeff's room, jabs a syringe into the man's thigh and proclaims him healed. Jeff immediately starts feeling better. House informs him that the thymoma is usually associated with PRCA and myasthenia gravis. They can take Jeff's thymus out and everything else will be manageable. The miracle shot he gave him was only diagnostic.
Later that night, House limps through the empty hospital towards the therapist's office. He tells a maintenance man that he forgot his cane in that room and asks to be let in. once inside, House roots through a file drawer and finds Stacy's psychiatric evaluation. He begins reading the notes on her.