Age: 31.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Anion gap decreased, Antinuclear antibody positive, Arthralgia, Asthenia, Bacterial test positive
Clinical narrative: First vaccine was on December 28, 2020. Rash on knees and legs on January 13, 2021 with referral to allergist from PCP on January 14, 2021.  Hands became red and inflamed on January 20, 2021.  Left eye became dry and swollen on January 28, 2021.  I was referred to a Cornea Specialist on January 29, 2021 and was told I had corneal abrasion.  May 19, 2021, discoloration/melisma on forehead after sun exposure. Face became red with a rash on nose and cheeks on June 28, 2021.  Rashes on legs and face would come and go throughout 2021 but did not cause any pain.   Received the booster on November 30, 2021 and had a rash on nose, cheeks, and eyelids on December 11, 2021.  Also on December 11, 2021, fingers/joints were red and swollen with minor joint pain.  December 21, 2021, I developed a rash on the back of lower left leg.  January 1, 2022, developed a large rash on neck following contact with beads.   February 23, 2022, developed rash around knees that gradually faded that night.  March 5, 2022, left thumb and index finger became red, hot, and inflamed which then spread to the rest of my left hand.  March 8, 2022, rash on upper thigh, knee, left arm, and fingers.  March 9, 2022, developed an itchy rash on chest that lasted a day.  March 10, 2022, hands were red, swollen and hot after shower.  No pain and faded a after a few hours.  March 13, 2022, Knees and thighs started developing patchy red rashes and purple discoloration in knees.  Decreased appetite/nauseas followed.  March 14-19, 2022, knees swollen, purple, red, and blue that resembled bruising w/o pain.  Rash on legs, cheeks, and hands that felt hot/inflamed.  Joint pain followed in my knees and hands.  March 24, 2022, continued knee discoloration and joint pain in knees/ankles.  Hands were swollen, red, and inflamed, specifically my right thumb which developed a blister.  I had went to the ED as a result and was referred to a rheumatologist. March 25, 2022, joint pain/swelling in hips, knees, and hands.  PCP sent me out for x-rays that day.  March 26, 2022, cramping and joint pain in hands while trying to type at work.  Developed rash on wrists later that night with wrist pain.  March 27, 2022 ? April 2, 2022, hands were swollen, tender, red, with joint pain in fingers.  March 28, 2022, went to the ED for tachycardia/chest pain and was told to f/u with PCP.  Developed low-grade fever on March 29, 2022 and f/u with PCP who prescribed Mobic for inflammation.  In addition, a cyst developed on right breast that was drained during this appointment. That night, I woke up with a red/hot/swollen nose, cheeks and swollen lymph nodes.  March 30, 2022, no appetite, weak, lightheaded, lethargic and continuous joint pain in hands.  Hands were either too hot or too cold.  PCP sent an urgent request to see a Rheumatologist for aforementionend symptoms and appt was made to see Rheumatologist for April 12, 2022. April 1, 2022, swelling in hands went down but had swollen lymph nodes.  April 2, 2022, both hands were extremely dry with minimal pain.  April 12, 2022, appt with Rheumatologist and tests were ordered to check antibodies/immune response via lab. April 15, 2022, lymph nodes still swollen and had appt with Endo.  During appt, BP was low and I was sent to the ED for fluids. April 25, 2022, multiple random bruises and red purpura on body. Also had lost 10 pounds since March 25, 2022.  Dx with POTS syndrome on April 25, 2022 and PCP ordered monthly IV fluids as a result, which I still receive today.  May 10, 2022, f/u appt with Rheumatologist regarding positive ANA and autoimmune-related symptoms. Upon assessment, Dr. discussed being in the early stages of several different autoimmune diseases.  Autoummune diseases he mentioned during examination was early stages of Lupus (SLE), Psoriatic Arthritis, Sjogren?s Syndrome, and Mast Cell Disease. Continuing to follow with Dr. Discussed starting me on Hydroxychloroquine but decided to wait on more testing/follow-up before starting any treatment.  July 18, 2022,  bruises on legs for unknown causes and swollen lymph nodes around thyroid.  PCP sent referral to Gastroenterology for possible intestinal malabsoroption and ultrasound of Thyroid. Gastroenterology appt was August 29, 2022 and recommended I schedule a Colonoscopy/Endoscopy.  Had to reschedule said test due to being positive for Covid on October 5, 2022.  October 9, 2022, went to urgent care for ongoing tightness and pressure in chest associated with Covid.  Dr. ordered chest x-ray which showed Acute Costochondritis junction syndrome and I was prescribed Codeine at night.  October 10, 2022, attempted to see my PCP for increased vaginal discharge/discomfort.  PCP sent in prescription for Flucanazole due to symptoms suggesting yeast infection.  Symptoms disapattted then returned 3 weeks later with pain/swelling.  Returned to urgent care on November 7, 2022, examination showed cellulitis of left labia and I was prescribed Clindamycin 300mg 4x a day for 10 days.  November 8, 2022, went to ED following increased dizziness, lightheaded, and fingers were purple when standing up.  Received IV fluids due to symptoms being associated with POTS and was switched to Bactrim from Clindamycin.  Symptoms improved after taking Bactrim for 10 days.  December 9, 2022, left eye became itchy, swollen, red and did not improve the next morning.  December 10, 2022, went to urgent care and was diagnosed with Acute Bacterial Conjunctivitis of left eye.  MD at urgent care prescribed prednisone for swelling and sulfacetamide sodium ophthalmic solution eye drops.  Recommended by urgent care to not return to work for two days and f/u with eye doctor if symptoms continue.  December 13, 2022, symptoms did not get better/started having flare ups and had appt with eye doctor, Dr., who recommended to stop eye drops; start on Clindamycin for infection.  Symptoms improved after a couple days of being on Clindamycin.  Ongoing symptoms today: flare ups around nose/cheeks, joint inflammation/redness/swelling in fingers, lightheaded when standing up for too long, low blood pressure, skin sensitivity to cold/hot temperatures, headaches, fatigue, random bruising that will linger for weeks, weight loss and inability to gain weight.   Scheduled for Colonoscopy/Endoscopy on 2/21/2023 for inability to gain weight and family hx of Colon Cancer.  Treatment and outcome pending.