Age: 65.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: Antinuclear antibody negative, Bartonella test negative, Blood culture negative, Bone scan abnormal, C-reactive protein increased
Clinical narrative: 65 M f who was initially evaluated, sent to for further evaluation and admitted to our hospital.  Summary of his symptoms and work up below: -Patient had  myalgias, dry cough, and tested +ve for COVID on February 19th . Got monoclonal antibody. He was never admitted and recovered fully. -May 26ths he got his 1st pfizer dose and the next day after he noticed Left calf pain and swelling. May 29th his right leg and scrotum also became swollen and he developed a dry cough. -June 1st he went for an urgent orthopedics visit and had LE dopplers of the left side that were negative for DVT. He subsequently developed daily fevers up to 101-102, drenching night sweats, loss of his appetite and 20lb weight loss -June 8th went to the emergency room, at the time they did the following workup: - CT chest abdomen and pelvis  (2.6x2.3x2.9 liver cyst in segment VII      1.2 cm exophytic hypodensity posterior media mid to lower pole left kidney without hydronephrosis       The abdominal aort and its major branch vessels are normal in course and caliber      Small amount of free fluid small amount of fluid in the pelvis      No lymphadenopathy      s/p L hip arthroplasty       No splenomegaly) - Scrotal US (US scrotum with color doppler.       R testicle 4.8x 2.6 x2.8 with homogenous echoes      L testicle 4.9x 3.2 x2.8 with homogenous echoes "the fat within the R inguinal canal appears slightly more prominent compared to fat in the left inguinal canal with possible mild           edema. No mass, cyst or hernia seen. There is subcutaneous tissue overlying the suprapubic region that appears mild edematous with mutliple prominet lymph nodes measuring 2.0x0.6-1.1) - Blood work: CRP 163.2, D-dimer 1.68, ESR 55  Since then he continued to have bilateral LE edema, daily night sweats and fevers to 101-102, fatigue and brain fog. Wife who is an IM doctor was checking his temperature daily and he was 100-101 most days. His scrotum swelling became more asymmetric (R>L) so went to see urology again who repeated a scrotal US - we do not have the results of this. Per patient the urologist did not think there was an infection but  treated him with  bactrim for "anti-inflammatory effect". He only took a couple of days of this then stopped because he did not think it was helpful.  On 7/12 PCP ordered: Blood cultures, HIV, bartonella, mono screen, legionella IgM, SPEP and thyroid studies--all negative Per patient he also got a PPD that was negative.  He was also sent for a TTE and it was unremarkable. PCP also empirically gave the patient doxycycline for 7 days.  On 7/22 he had a bone scan that showed "increased uptake in bilateral ankles, knees, forearms, mid right femoral diaphysis (patient reports getting injured in R femoral from accident 5 years ago). "I therefore assume the findings relate to a hematological malignancy or metabolic bone disease. A BM biopsy may be necessary"  His symptoms did not get better when he was on doxycycline and he continued to fever.  -On 7/26 he was referred to medical facility, where they recommended inpatient admission for expedited work up.  In the hospital, he remained afebrile x48 hours for the first time. His CRP declined to 101 (from 167 outpatient) and his platelets also declined. HIV, Trp Ab, Blood and urine cultures were negative.  RF and ANA negative, thyroid function studies negative, SPEP/UPEP and blood smear pending. CT Torso again showed renal lesion but resolved pelvic lymphadenopathy. Seen by heme/onc, rheum andID consults.  Given rapid improvement without intervention, he was discharged to follow up with his PCP