Question: Hello- Could you please review my chest ct's that I am attaching. I am forty and in the last 2 years my health has had a drastic change for the worse. I am sure you will see the chronic nature and the huge work-up that we are still trying to piece together. I had a documented case of anti-NMDA receptor encephalitis and now dealing with the sequelae and manage the other issues the work-up has discovered. I am concerned about lymph nodes that have developed in my neck and apparently in my chest. I have used either remicade or humira since 2003 and know the risks. I am now also dealing with severe fatigue and functional anemia which shows ferritin deficiency, zinc protoporphyrins and I have normal serum iron levels. Any advice will help. Thank you, XXXXXXX

1. Why you had two consecutive CT thorax in 1 month interval? I mean what was the indication?
In september 2015 something was spotted in a chest x-ray showing a new nodular shadow at the medial right base. In october 2015 I was diagnosed with anti-NMDA encephalitis, and don't remember alot from that time frame.

2. What were your symptoms in September and October 2015? What are your chest symptoms at present? Symptoms were severe fatigue, chest wall pain, new onset tachycardia with elevated bp, night sweats, flushing, expiratory wheezing, shortness of breath and then I even developed pericarditis after the second Immunoglobulin G treatment so I was started on steroids. They are always noting left sided mastoid opacification or left mastoid disease, but I've been through 3 full course of antibiotics including Bactrim, Cipro and Xifaxin (for the crohn's/gi flora normalization).

3. What about neck lymphnodes? Do you have any reports for this? Yes, I will attach them. The right side of my neck and face is noticeably puffy and swollen to the point that people make comments. I also have swelling of my hands and feet that pits on my shins.
There are so many things complicating each other, that I really don't what is what anymore. I just am trusting my gut that something is still not back to my baseline. I still have fatigue and profuse sweating with facial flushing. And they have me seeing a hematologist next week for the functional anemia with zinc protoporphyrins seen in my blood work. My Endocrine Dr keeps saying that I have porphyria and it seems accurate, but the lab specialist in XXXXXXX said that my lab numbers would have been significantly more elevated.
I am thinking I may go to the Mayo clinic, because I am better, but not back to baseline and stress or two much physical exertion causes me to be out of breath and super weak and tired. So I am not even well enough yet to go back to work but cannot afford to be off much longer :(

thank yo and i will attach what I have.

oh, i forgot..there was a swelling in my right throat that they biopsied and it was benign. Please let me know if you would like any other reports.

https://drive.google.com/open?id=00000000

great, thank you very much. I do believe this may all be autoimmune.



https://drive.google.com/open?id=M)0000000000