Reza

At the end of the day, when you have diffuse lymphadenopathy, the first question is, can you get to a diagnosis without requiring a biopsy?

And there's a few instances you can, and they've already sent a monospot.

The lack of LFT abnormalities, the lack of atypical lymphocytosis really lessens the likelihood of those diseases of infectious mononucleosis, which includes HIV, EBV, CMV, toxo.

But then...

Additionally, you worry about autoimmune that Robbie said, I know we're not too concerned, but the autoimmune diagnosis you can make without biopsy, lupus, Sjogren's, very easy just through serology.

Then there's other, you know, viral syndromes, hep C, HIV.

I would definitely send an HIV test.

Maybe it's already been sent.

It absolutely needs to be sent.

But then you're like, could this be lymphoma?

And

I would have to see if lymphoma can cause these migratory oligoarthritis.

In the cases of lymphoma I've seen, now I'm doing like an illness script matching to the problem representation.

I can't really recall like oral ulcers and like these skin findings that you described on the patient's knuckle.

But now I'm worried about a diffuse...

inflammatory slash infiltrative syndrome that is, I think the oligomigratory is just immune dysregulation and you're seeing it jump from joint to joint.

But beyond lymphoma, Robbie, I don't know what else.

The splenomegaly and diffuse, like I don't think it's IDG4 disease with the retroperitoneum.

I don't think it's solid metastatic cancer.

But now I'm just like reflexively thinking.