Age: 25.0
Sex: F
Vaccine: COVID19-2, FLUX
Symptoms: Tonsillectomy, White blood cell count normal, X-ray normal
Clinical narrative: Nov 10, 2022: Received the COVID Moderna bivalent booster & Flu shot   - Experienced flu-like symptoms a day after  - Tonsils began swelling about five days after (no sore throat)  - Difficulty talking/pronunciation, increased snoring, uncomfortable to swallow - Persisting stuffy nose  - On/off dry and wet cough  Multiple visits to the Urgent Care and Clinic  - Tested for strep four separate times (ALL negative), at-home tests for COVID all negative - Given a round of steroids for two days, did not help swelling of tonsils  Dec 12, 2022: Saw primary care doctor   - Lab tests from blood all normal, no strep, no mono, inflammation markers (sedimentation rate, CRP, and white blood cell count) all normal suggesting I did not have a current bacterial infection  - Recommended I see an ENT for the inflamed tonsils and runny nose  Dec 15, 2022: Saw ENT (Dr.) - Inflamed tonsils, no labs or tests  - Said I could have a bacteria colonization called actinomyces (cause unknown)  - Given round of antibiotics (Amoxicillin-Clavulanic/Augmentin 875-125MG) taken twice a day for 10 days (only took for five days, see below)  - If antibiotics did not work to reduce inflammation in tonsils, the next step would be to have them removed   Dec 16, 2022: Right ankle swelling  - Felt like a sprained ankle: limited movement, hurt to touch, swollen across the top and outside ankle - Swelling got worse as days went on, could hardly see my ankle bone  - Ice, elevation, ibuprofen, and rest helped   Dec 19, 2022: Went to orthopedic walk-in clinic  - X-rays normal - Could not explain swelling of ankle or attribute a sprain to any previous injury (started working out but did NOT roll ankle or injure it in any other way)  - Doctor told me to stay off the ankle, ice, take ibuprofen and elevate for a week - Symptoms improved within a few days after   Got home from clinic and noticed a small rash on the top of my right foot (underneath toes), same side that ankle was swollen  Dec 21, 2022: Rash got worse on right foot and began forming on left foot, a few spots on stomach (not as bad as foot) - Last dose taken of first antibiotic (see tomorrow?s notes)  Dec 22, 2022: Called ENT office and told nurse about rash (thought it was a reaction to medication) - Switched antibiotics to Clindamycin HCL 300MG taken three times a day for 10 days (began taking Dec 23, 2022) - Noticed inside of belly button was red, inflamed and itchy that night  - DID NOT TAKE ANY ANTIBIOTICS THIS DAY   Dec 23, 2022: Rash moved all the way up my legs  - Taking zyrtec twice a day (helped with inflammation and redness, but Benadryl helped more)  Dec 25, 2022: Swollen left knee cap - Incredibly painful to walk on and bend  - Started to feel better about two days after the initial onset (some pain still present but can put pressure, walk, and bend) - No injury or fall to report that would cause this pain   Rash still present, seemed to be fading, tonsils still swollen but not as enlarged   Jan 1, 2023: Leg rash incredibly inflamed after showering - No more rash on feet, fading at the ankles, but the rest of legs looked awful  - Last dose of second antibiotic   Jan 2, 2023: Woke up with painful cramping near belly button  - Ibuprofen helped  - Continued for about 4-5 days before stopping - Primarily occurred in the morning right after waking up, constant cramping, tightness, and bloating    Jan 4, 2023: Whole rash began fading  Jan 6, 2023: Rash almost gone   Jan 7, 2023: Left wrist swelling and pain plus rash came back on ankles/lower calves/top of feet  - More inflammation and redness, VERY itchy and burning sensation  Jan 9, 2023: Rash on ankles, still irritated   Jan 10, 2023: Followed up with primary care doctor (Dr.)  - Discussed rash and joint swelling  - Recommended I see the dermatologist to discuss rash  Jan 11, 2023: Saw dermatologist  - Rash diagnosed as Leukocytoclastic Vasculitis (may be caused by antibiotics or an infection)  - Skin biopsy taken to rule out reaction between immune system and blood vessels in skin; may be associated with a longer term kidney problem (IGA vasculitis)   Test results came back and confirmed IGA vasculitis. Rash came back worse again, dermatologist prescribed triamcinolone acetonide 0.001mg topical ointment for inflammation/itching  Jan 17, 2023: Follow-up with ENT about rash, joint swelling, and continued inflamed tonsils; recommended tonsillectomy   Jan 23, 2023: Tonsillectomy  Jan 29, 2023: Due to complications from the original tonsillectomy (bleeding/hemorrhaging), I had to go to the emergency room and get another surgery to re-cauterize the area to prevent additional blood loss  Biopsy from tonsils revealing normal, but inflamed tonsils (no infection present, unknown why they were inflamed)   Feb 9, 2023: Healing from tonsillectomy fine, rash has not reoccured (completely gone), no additional joint swelling. However, there is recurrent pain in left knee from the swelling that occurred in Dec.