Age: 63.0
Sex: M
Vaccine: COVID19
Symptoms: Histamine intolerance, Impaired work ability, Laser therapy, Lichenoid keratosis, Mast cell activation syndrome
Clinical narrative: April 10, 2021  received J&J vaccine. About two weeks later, my ears began to flush on a daily basis, as well as every night. Burning flush might involve L ear, R ear, or both. There are both identified and unidentified triggers. The identified triggers include: heat, touching the ears, wearing a mask, exercise or physical exertion, anxiety, anger, frustration or negative thoughts, any social interaction such as shopping or talking to people in person or on the phone, showering and shaving, bending down, squatting or turning my face downward, chewing, especially hard foods. 6/21 - Condition diagnosed as Red Ear Syndrome. Additional information for Item 18:  The following treatments have been prescribed (all proved ineffective): o Ketaconazole 2% topical o Doxycycline 50mg o Hydrocortisone 2.5% topical o Metronidazole 1% topical o Rhofade 1% topical o Niacinamide 500mg o Tacrolimus 1% topical o Timolol Maleate 0.5% topical o Brimonidine niacinimid .4%/4% topical o Nortriptyline 40mg o Gabapentin 1200mg o Cyclobenzaprine 15mg with indomethacin 150mg o Paroxetine 60mg o Venlafaxine 150mg o Propranolol 20mg o Plexion topical o Minocycline 1.5% topical o Azelaic acid 15% topical * Minocycline 100mg Treatment with numerous mood-altering prescriptions seems was accompanied by a heightened anxiety, and a lessened capacity to focus, organize thoughts, or complete tasks  this condition remains.  08/21/21  Woke up with stiffness in my lower legs; shins and ankles were covered with petechiae. Urgent care doctor noted "some sort of rheumatoid vasculitis." Legs cleared up in a couple of days. 09/20/21 - Rheumatologist concluded no rheumatoid arthritis; speculated that event may have been caused by an unknown virus. 01/2022  Daily flushing experienced in ears spread to my face, has continued to increase in duration and intensity. This was accompanied by increased redness and soreness of the eyes. Switched jobs within the company I work for; could no longer wear the PPE due to overheating and profuse flushing. 02/22  Surgical nerve block procedure performed; no overnight flush the next morning, but it returned later that day. 05/22  Second nerve block procedure, results were the same as in Feb. 06/12/22  I fell and fractured my coccyx, and suffered a concussion. 07/22  Asked the dentist about a recent issue with extremely dry mouth; she alerted me to Sjogren's Syndrome. 07/22  Bumpy rash approximating the lupus "butterfly mask" appeared overnight in addition to normal flushing. It disappeared and reappeared numerous times over the next 10 days, included peeling skin and small itchy hives on the ears. 08/22 - Rheumatologist noted that I displayed many of the markers of lupus, but bloodwork did not support that diagnosis. 08/9/22  Tele-health diagnosis of MCAS and histamine intolerance. Treatment included Ivermectin, vitamins and supplements, intermittent fasting to stimulate autophagy, naltrexone, Vascepa. Within 4 weeks, autoimmune symptoms subsided. Flushing of the face and ears continued, as well as the "hair trigger" anxiety which often causes the flushing. 11/21  Provider discussed my case with medical colleagues; of the various suggestions made for addressing the facial and ear flushing , I have incorporated a low histamine diet, whole body vibration, daily cold showers, mild hyperbaric oxygen therapy (46 sessions), and supplements NAC and nattokinase. None have thus lessened the flushing. 02/23  Received pulsed dye laser treatment to lessen the permanent redness that has developed in my face; no improvement noted. Developed sores and peeling skin on hands, diagnosed after biopsies as lichenoid dermatitis, hydroxychloroquine prescribed due to association with lupus. 04/23  Flushing in face less uniform, more blotchy with darker raised areas. Occasional peeling of skin after intense episode of flushing. Cold air, or cooling with spray bottles, fans, or air conditioning temporarily reduces the flushing. However, flushing occurs during the day without constant management of symptoms, and at differing levels every night despite maintaining a cool sleeping environment. The amount of exertion needed to precipitate the burning flush has come to include tasks as simple as raking or carrying a full trash bag to the garbage can. I am currently on leave of absence from work, which was urged by my employer due to my diminished performance.