Age: 25.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Tryptase, Ultrasound spleen, Urine analysis
Clinical narrative: Was sent to the emergency room for shingles like pain around hips, back, and stomach, on October 13, 2021 (note: I had shingles in Jan of 2019 located on middle left back). The doctors performed an Abdominal CT scan found enlarged lymph nodes in the retroperitoneal para-aortic region. Nothing found was able to tell them what was causing the pain. Spleen and Liver were noted as unremarkable and not enlarged. October 20,2021, I received a Thoracic MRI which showed an increased T2 signal through T9-T10 measuring approximately 4x2x23 mm in transverse (was still having shingle like symptoms at this time).  approximately 25 days later another MRI w/contrast was performed and was not able to detect mass/abnormality. I was prescribed Gabapentin for 30 days and it helped after 2 weeks of taking it. On October 25th, 2021, I was having pain  in my left side under my ribcage. An Abdominal MRI was performed and found that my spleen was 16.2 cm large. and that I had Left retroperitoneal lymphadenopathy. Was not prescribed anything for pain. I believe I was given prednisone after this for approximately 1 week and it seemed to have made me feel worse. On November 19th,2021, I got another abdominal ultrasound done and spleen spleen was again noted to be enlarged at up to 15.4 cm in cc dimension, up to 11.7 cm in AP dimension, and up to 4.8 cm in transverse dimension. Lymph nodes were noted as not significantly enlarged this time. Fast forward to January 20,2022, I received another Abdominal CT scan because I was still having pain in my left side and having trouble sleeping because I can only sleep on my stomach.  Liver: Normal size and surface contour. Mild hepatic steatosis. No suspicious lesion. Spleen: Splenomegaly measuring 12.4 x 6.5 x 16.0 cm (AP x TR x CC), previously measuring 11.7 x 4.8 x 15.4 cm. No suspicious lesion.  Lymph nodes: Multiple enlarged periaortic and aortocaval lymph nodes are again noted (series 2): for example, a 2.4 x 1.5 cm left para-aortic node (image 35), a 1.7 x 1.7 cm aortocaval node. February 2nd, 2022 a PET scan was performed and  found Lymph nodes: Enlarged hypermetabolic left axillary lymph node, max SUV 6.42. Query any recent vaccinations especially Covid vaccination in the left arm. Last vaccination date in the left arm was 10/12/2021. Liver: Hepatomegaly. Spleen: Splenomegaly. Lymph nodes: Multiple enlarged hypermetabolic retroperitoneal lymph nodes. Example nodes: -Left periaortic conglomerate, 2.5 x 2.4 x 1.5 cm, max SUV 9.15 (series 3, image 344) Additional enlarged mesenteric lymph nodes with no significant activity. Example node: -Right hemiabdomen, 0.9 cm in short axis (series 3, image 369) -Bulky right pelvic sidewall lymphadenopathy including common iliac, external and internal iliac nodes. Index large node along the right pelvic sidewall, max SUV 9.95, overlapping loop of bowel. After performing the PET scan, I was scheduled for 2 biopsies of approximately 4 lymph nodes. 3 located in the let axillary region and another in the abdominal region. All biopsies came back normal and were noted as being reactionary lymph nodes. Once again, I got another abdominal Ct scan done on March 10th, 2022, because I was still having left side pain. The CT scan showed again that the liver is diffusely hypo attenuated as can be seen with hepatic steatosis. There is no suspicious enhancing lesion.  The liver measures 17.2 cm. Spleen: The spleen measures 15.7 cm CC. Lymph nodes: There are enlarged retroperitoneal lymph nodes measuring up to 15 mm short axis, axial image 37. There are mildly enlarged right lower quadrant mesenteric lymph nodes measuring up to 1.0 cm. There are right greater than left enlarged pelvic lymph nodes measuring up to 1.6 cm at the right external iliac chain. These are grossly stable. This was the last scan that I have had done, I will be getting more in the next few days. Also, note during this time I had severe Diarrhea for approximately 65 days, along with light headedness, dizziness, tiredness, blood flow to my feet problems and soreness after very little activity. Almost every blood test imaginable has been completed and nothing still has been found.