Age: 69.0
Sex: M
Vaccine: COVID19
Symptoms: Lung opacity, Magnetic resonance imaging spinal abnormal, Muscle atrophy, Muscle twitching, Myalgia
Clinical narrative: A 69 y/o male complaining of myalgia, diffuse, boring muscle aches, and progressing arthritic pain, MTP joint R. foot, R. shoulder, and progressing cervical spine spondylosis, thoracic, and lumbar arthritis. 2) Interrupted sleep with posturing, nocturnal generalized isotonic contractions of extremities x 7 months. 3) Muscle twitching, more pronounced in R. gastrocnemius. Muscle atrophy or sarcopenia. 4) Abnormal weight loss, about ten pounds, (149lbs-138lbs), over six months despite an abundant appetite of three meals daily and a sedentary lifestyle of study. 5) Increasing fatigue. History of Present Illness: Patient noticed rapid deterioration in March/April 2021. The patient received Pfizer vaccines Jan 13, and Feb. 3, 2021. Patient returned 4 Jan. 2020 after auditing Linguistics classes at university where he was active with study, walking about five miles a day between university classes and beginner piano lessons in the evening.  He registered in the master's in Teaching as a Foreign Language at a college, planning to volunteer teach in retirement, Language Arts to refugees and prisoners. The college offered the Pfizer vaccine, after completing twelve graduate credits, he had to withdraw from the program in May 2021 and ceased all other studies after a sudden deterioration in health. He stated that he noticed the same trousers he wore dragging on the ground when he walked and felt like my telomeres were tuned off, and I had aged ten years in a few months.? Patient complained to primary care physician  about eating without weight gain. Physician discounted parasitic etiology multicellular organism would cause an eosinophilia. presumed genetics [his constitution]. Insisting, the pt. c/o nocturnal isotonic muscle contractions and posturing. The physician ordered a sleep study:  Dx. severe obstructive Sleep Apnea was diagnosed. Pt. went to Emergency for worsening nocturnal posturing. An E.D. CAT scan of the brain evidenced nothing emergent and normal sinus ventricles. As progressing myalgia and arthritic pain continued, pt. consulted an urgent care physician at hospital and complained of Trichinella like muscle pain with severe arthritis pain and osteogenic enlargement of right MTP joint and asked for a workup. The M.D. recommended ceasing statins and ordered lab tests. Myalgia alleviated the first week off Atorvastatin, but the arthritic pain continued and then involved the cervical vertebral area.  After noticing further weight loss, Pt. consulted another Internist who ordered a full body CAT scan and a G.I. series to r/o occult neoplasia. When images and G.I. series did not evidence a neoplasia, Pt. postulated a parasite infection. Infectious disease referral was declined due to lack of eosinophilia and a negative stool test. A course of Azithromycin was given for ground glass infiltrate pulmonary lesion described on CAT scan with recommendation to repeat imaging in a month to r/o hidden neoplasia. Pt. consulted a third Internist who acquiesced the possibility of a parasite or house mold etiology considering the confounding symptoms involving pulmonary and sinusitis history with fatigue and weight loss, and considering symptoms are worse at night when in bed, but M.D. could not find a test to pursue workup. Pt. consulted a fourth internist who repeated stool analysis and rheumatoid lab tests, but tests were negative. Pt. asked for an Infectious Disease referral which was forwarded but declined by I.D. physician stated there are many assumptions to connect the symptoms according to pt's hypothesis. Pt. consulted two neurologists for nocturnal posturing with isotonic muscle contractions and daytime muscle twitches.  An EMG of R. arm and R. leg showed evidence of cervical nerve compressions. No cause was ventured for nocturnal posturing, but neurologist dispelled the possibility of A.L.S.  A trial of Rx/ Medrol steroid therapy was given. Pt. felt some relief. Pt. consulted a neurosurgeon; the physician assistant ordered an MRI of cervical spine: multiple level spondylosis was diagnosed. The neurosurgeon stated that the marked cervical pathology did not explain the various symptoms and recommended consulting an academic medical center because of complexity and correlation of symptoms with dates of mRNA vaccination. On his annual dermatology visit in 2021, Pt. had a basal cell carcinoma removed from nose. He requested Rx/ Ivermectin for demodex and rosacea. After completing the single dose, he noticed his appetite markedly decreased for about three weeks. At that time, suspecting a parasite infection, the pt. took Albendazole 400 mg. for three days. Pt. gained about 2lbs. The next month his appetite began to increase. Cardiologist does not feel fatigue and symptoms are cardiac related based on annual stress test. Based on his clinical intuition, the pt. hypothesizes a parasitic and autoimmune etiology causing increased appetite and weight loss, sudden and progressing osteoarthritic changes, CAT scan lesion in R. upper quadrant of ground glass infiltrates as possible evidence of larval transit, decrease in appetite after a dose of Ivermectin, and the correlation in the chronology of mRNA vaccination with sudden onset of illness. Pt. believes he initially acquired a parasite years ago on an extended trip 07 April to 05 July 2007. The pt. feels that the cervical arthritic pain is rapidly worsening and progressing over weeks with aches in the cervical, midthoracic, and lumbar area. Pt. fears rapidly becoming disabled from progressing myalgia and arthritis. PM Hx. Coronary artery disease, hypertension.  PSx Hx: Coronary stents x 4. Meds. Aspirin 82 mg/daily. Atorvastatin 40 mg/daily (ceased because of myalgia). Losartan 25 mg/daily; Labs. h/o Mild normocytic, normochromic anemia and thrombocytopenia.