Reza

But at this juncture...

I'm really worried about an auto-inflammatory disease or an auto-immune disease, given his age, or a disseminated STI based on the problem representation that I've synthesized with you guys today.

Can I just make a quick interjection for old time's sake?

I told my team to get a CT test out on pelvis in a patient the other day, and this has never happened.

The radiologist called after they read it to be like, why did you order this study?

Because it was that normal.

Oh my gosh.

Yeah.

I think it's so interesting because when you said nightly fevers, um, you know, they, they use terms like quitodian.

I don't even know if I'm pronouncing that correctly or Pell Epstein's fever where they come and go.

And I was like, could this young guy have lymphoma?

And then you're telling us you have night sweats.

And so what I'm going to update the problem representation with, in addition to migratory oligoarthritis, which I think later when I read about it and will add so much value in future discussions, but unfortunately right now I don't have a great schema for it, is lymphadenopathy.

splenomegaly.

So something happening in the reticuloendothelial system.

And when you have this, it's not isolated lymphadenopathy, right, Robbie?

This is diffuse, and it's involving the retroperitoneum.

So when you're approaching lymphadenopathy,

And quite frankly, that's where I would anchor my thinking in, is both the enlarged spleen and the lymph nodes.

And then when I list diagnoses, I would see if they could explain the migratory oligoarthritis, the aphthous ulcers that this patient's experiencing, and the cutaneous findings that they're also experiencing.