Anybody Have A Clue What This Is?

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DoIReally42
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#1
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#1
Patient presenting to the ED, he's been to a couple over the past few months. He looks visibly upset and worried. He's complaining of loss of appetite, shivering/tremor, visual eye floaters, extreme anxiety/fear, restlessness, reduced sensation to touch and intrusive/irrational thoughts. Blood work came back normal (CBC, CMP, Lipid Panel, TSH) Physical exam is unremarkable. Blood pressure is elevated, 155/95, pulse 103, respiratory rate 22. Brain was Imaged by MRI, which was unremarkable.

Patient also complains of labile blood pressure, he reports that blood pressure fluctuates shooting up and going back down in minutes, he said he wakes up in the middle of the night describing an "icy hot" feeling in his blood and when he checked his blood pressure, he reported that it was 170/100.

Patients family members say the symptoms began suddenly overnight and have been at a peak for over 3 weeks. Patient was on 30mg Buspirone, 50mg Seroquel, and 20mg Lexapro when this happened. Patient was tapering Seroquel the week of symptom onset. Patients Psych has discontinued Buspar and increased Seroquel back to original dose of 150mg. Despite this symptoms have not improved at all.

Patient has a history of social phobia but denies panic attacks ever. He denies hallucinations/delusions. He says he's stopped going to school, sleeps on the floor in his sisters room and is constantly in fear and hyper vigilant. Patient shows absence of delirium or any cognitive issues. Family says that he's never been like this before and are frustrated with going to different hospitals. He has been on Seroquel and Lexapro for 2 years without issue, beginning both for sleep and social anxiety. Buspar 30mg was added 2 months before symptoms began to help with anxiety.

Previous psychiatrist at an inpatient psych facility suggested increasing Seroquel to 200mg which was done on an outpatient basis, but symptoms have not improved.

Buspar was discontinued 4 weeks ago, Seroquel was increased 6 weeks ago.

Any differential diagnoses? What are your thoughts?
Last edited by DoIReally42; 4 weeks ago
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the bear
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have they been screened for Lyme disease ?
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DoIReally42
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No, but dosen't that present with a bulls-eye rash?

One colleague is suggesting LCM (rodent borne) Virus because patient plays with a few pet hamsters and sometimes doesn't wash his hands, but he says his siblings do that too, and they exhibit no symptoms.
(Original post by the bear)
have they been screened for Lyme disease ?
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the bear
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(Original post by DoIReally42)
No, but dosen't that present with a bulls-eye rash?

One colleague is suggesting LCM (rodent borne) Virus because patient plays with a few pet hamsters and sometimes doesn't wash his hands, but he says his siblings do that too, and they exhibit no symptoms.
Lyme disease has a plethora of symptoms; in a disturbed psychiatric patient some could be overlooked.
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DoIReally42
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(Original post by the bear)
Lyme disease has a plethora of symptoms; in a disturbed psychiatric patient some could be overlooked.
True, however how long after infection would antibodies be detectable through blood? For example performing a: Lyme Disease Antibodies (IgG, IgM), Immunoblot
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the bear
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(Original post by DoIReally42)
True, however how long after infection would antibodies be detectable through blood? For example performing a: Lyme Disease Antibodies (IgG, IgM), Immunoblot
according to this source:

https://www.lymediseaseaction.org.uk/about-lyme/tests/

the antibodies may be detected several years after infection.
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Guru Jason
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#7
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Chase always asks if it's lupus. House usually shuts that down though. Did you try lupus?
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