I am an 18 year old female. I am not pregnant. I first presented with fatigue and a lump the level 2 region of my left lymph nodes four months ago. Over the next few months I slowly developed worsening night sweats, joint pain, and bone pain. The pain is mainly in my hips, shoulders, and spine, but over the last two weeks it has expanded to my ribs and my sternum. I moved to college around 2.5 months ago and since then I have gotten like two or three colds (my friends would also be sick at this time and we had the exact same symptoms). I don't normally weight myself because I have a history of some eating disorder behavior, but my friend got a scale so I tested it out. My last weight was in late May and I was 111.1 lbs, but when I weighed myself in mid August I was 96.7 lbs. (I am 5 foot 3 for height context)
I went to the wellness center and they ordered a TSH and some basic blood work. (I will include all my bloodwork results at the end). A few days later they had me go to the ER after I came in with shooting pain around the right side of my belly button, nausea, and left shoulder pain. They also ran a bunch of labs there and I got a CT Scan, everything came back normal so I was sent home. I went back to the wellness center around two weeks later on September 22 because my symptoms were getting worse. They did a mono spot test, T4 free and T3 free tests, and checked me for Lyme disease. Everything came back normal and they told me to make an appointment with an internal medicine doctor if my symptoms continue.
I saw a GI doctor on October 1st because I was having some extreme abdominal bloating (my skin was stretching to the point of pain) and because of the unexplained weight loss. The doctor thought I might have a weird form of Crohn's disease due to family history, but suggested I just try a fiber supplement and see how that works.
I saw an internal medicine NP on October 6th. I pointed out my symptoms and the lump in my lymph node. She noticed a few more and ordered a neck ultrasound for me. I had the ultrasound the next day and they noticed lymph nodes up to 3.5 cm in size, and a nodule on my right thyroid. It is worth noting that I woke up that morning sick with a cold (I had a stuffy nose). The NP then ordered a bunch of lab tests which I got done on October 8th. I have a family friend who is a doctor in Boston, so my parents put me on a flight there on October 9th.
I had a moment of almost passing out when I arrived in Boston, my vision started flashing yellow and I had to sit down for a few minutes. This was the first time this has happened to me. I went to get a bunch of lab work done on October 10th, and I almost passed out again during the blood draw. This is weird because it has never happened to me before (even though I have had lots of blood draws before) and we were only on the first vial. I have a CT Scan of my neck and pelvis/abdomen on the 11th. I then met with a lymphoma specialist on the 12th and he ordered more tests. I also had a biopsy done of my thyroid nodule and the originally noticed lymph node on October 19th.
The weirdness of this all comes from my labs. I tested positive for the original EBV antibodies (IgM), but no other antibodies. My CMV antibodies were very high, but my viral load was not detected. My doctor said that it is highly unlikely that I actually had back to back CMV and EBV because it only really happens in patients who are immunocompromised (which I have no reason to believe I am). However, he does not know which one is the false positive because I should not be having such a strong current reaction if I had past CMV, and I couldn't have had EBV for four months based on my antibody count. Also, my spleen is fairly enlarged, as is my liver, I have new nodules on my lungs that weren't there on my September CT Scan, and I have a small pericardial effusion. My ferritin levels are high and I am anemic even though my iron levels are good.
I am really scared and confused on what is happening. I would really appreciate any insight into what could be going on. We are still waiting on my biopsy results and a blood flow cytometry interpretation. I have included my bloodwork from the past year (in case trends are important), the CT scan results (if anything isn't listed in them it is because that organ/system was normal), my ultrasound results, and an EKG I had in May. The results are labeled with the date the bloodwork was done, and if a result doesn't have a date next to it then it was collected on October 10th.
Thank you so much for reading this, I know it is a lot of information.
Bloodwork
Uric Acid: 4.3
LDH: 554 (10-10), 483 (10-08)
C-Reactive Protein: 77.7 (10-10), 32.5 (10-08)
Sedimentation Rate: 22 (10-10), 16 (10-08)
Reticulocytes
Retic (%): 1.9
Immature Retic Fraction: 13.1
Absolute Retic: 0.07
Retic Hemoglobin Equivalent: 24.2
PTT: 30.4
PT-INR
PT: 13.8
INR: 1.2
Comprehensive Metabolic Panel
Sodium: 129 (10-10), 134 (10-08), 138 (9-11), 139 (9-11), 139 (5-15), 140 (5-06), 139 (1-17)
Potassium: 3.6 (10-10), 4.2 (10-08), 3.9 (9-11), 3.7 (9-11), 3.4 (5-15), 3.8 (5-06), 4.2 (1-17)
Chloride: 95 (10-10), 99 (10-08), 102 (9-11), 103 (9-11), 104 (5-15), 105 (5-06), 104 (1-17)
CO2: 23 (10-10), 28 (10-08), 27 (9-11), 25 (9-11), 27 (5-15), 28 (5-06), 24 (1-17)
BUN: 10 (10-10), 13 (10-08), 14 (9-11), 15 (9-11), 7 (5-15), 11 (5-06), 15 (1-17)
Creatinine: 0.71 (10-10), 0.76 (10-08), 0.7 (9-11), 0.73 (9-11)
Glucose: 92 (10-10), 84 (10-08), 88 (9-11), 95 (9-11)
Calcium: 8.8 (10-10), 9.6 (10-08), 10.2 (9-11)
AST: 66 (10-10), 15 (9-11), 15 (3-06)
ALT: 59 (10-10), 8 (9-11), 17 (3-06)
Alkaline Phosphatase: 110 (10-10), 66 (9-11), 64 (9-11)
Bilirubin, Total: 0.4 (10-10), 0.5 (9-11)
Total Protein: 7.5 (10-10), 7.7 (9-11), 8.2 (9-11)
Albumin: 4.1 (10-10), 4.9 (9-11), 5.1 (9-11)
Globulin: 3.4
eGFR: 126 (10-10), >90 (10-08), >90 (9-11)
Anion Gap: 11 (10-10), 7 (10-08), 9 (9-11), 11 (9-11)
Magnesium: 2.2 (10-10), 1.9 (1-17)
Phosphorus: 2.3
Manual Diff
Neutrophils %: 21 (10-10), 73 (9-11), 68 (9-11), 65 (5-15), 58 (5-06), 64 (3-06), 47 (1-17)
Bands %: 0 (10-10)
Monocytes %: 3 (10-10), 4 (9-11), 5 (9-11), 5 (5-15), 6 (5-06), 6 (3-06), 8 (1-17)
Eosinophils %: 0 (10-10), 0 (9-11), 1 (9-11), 0 (5-15), 1 (5-06), 1 (3-06), 1 (1-17)
Basophils %: 0 (10-10), 0 (9-11), 0 (5-15), 0 (5-06), 0 (3-06), 0 (1-17)
Myelocytes %: 1 (10-10)
Plasma Cells %: 1 (10-10)
Lymphocytes %: 23 (10-10), 22 (9-11), 26 (9-11), 29 (5-15), 34 (5-06), 29 (3-06), 44 (1-17)
- % of reactive/atypical lymphocytes: 51 (10-10)
Absolute Neutrophils: 3.69 (10-10), 8.17 (9-11), 7.44 (9-11), 5.3 (5-15), 4.5 (5-06), 6.7 (3-06), 3 (1-17)
Absolute Lymphocytes: 13.01 (10-10), 2.43 (9-11), 2.88 (9-11), 2.4 (5-15), 2.6 (5-06), 3.1 (3-06), 2.8 (1-17)
Absolute Monocytes: 0.53 (10-10), 0.43 (9-11), 0.54 (9-11), 0.4 (5-15), 0.5 (5-06), 0.7 (3-06), 0.5 (1-17)
Absolute Eosinophils: 0 (10-10), 0.04 (9-11), 0.07 (9-11), 0 (5-15), 0.1 (5-06), 0.1 (3-06), 0.1 (1-17)
Absolute Basophils: 0 (10-10), 0.03 (9-11), 0 (5-15), 0 (5-06), 0 (3-06), 0 (1-17)
Absolute Myelocytes: 0.18 (10-10)
Absolute Plasma Cells: 0.18 (10-10)
Immature Granulocyte %: 0.5 (9-11), 0.4 (9-11), 0 (5-15), 0 (5-06), 0 (3-06), 0 (1-17)
Absolute Immature Granulocytes: 0.06 (9-11), 0.04 (9-11), 0 (5-15), 0 (5-06), 0 (3-06), 0 (1-17)
CBC and Differential
WBC: 17.58 (10-10), 19.3 (10-08), 11.2 (9-11), 11 (9-11), 8.2 (5-15), 7.7 (5-06), 10.6 (3-06), 6.5 (1-17)
RBC: 3.8 (10-10), 4.13 (10-08), 4.47 (9-11), 4.45 (9-11), 4.33 (5-15), 4.22 (5-06), 4 (3-06), 4.29 (1-17)
Hemoglobin: 10.3 (10-10), 11.6 (10-08), 12.3 (9-11), 11.8 (5-15), 11.7 (5-06), 11.1 (3-06), 11.9 (1-17)
Hematocrit: 30.7 (10-10), 35 (10-08), 37.7 (9-11), 37.1 (9-11), 37.4 (5-15), 36.6 (5-06), 35.4 (3-06), 37 (1-17)
MCV: 80.8 (10-10), 84.7 (10-08), 84.3 (9-11), 83.4 (9-11), 86 (5-15), 87 (5-06), 89 (3-06), 86 (1-17)
MCH: 27.1 (10-10), 28.1 (10-08), 27.5 (9-11), 27.6 (9-11)
MCHC: 33.6 (10-10), 33.1 (10-08), 32.6 (9-11), 33.2 (9-11)
Platelet Count: 145 (10-10), 183 (10-08), 383 (9-11), 374 (9-11), 279 (5-15), 298 (5-06), 419 (3-06), 267 (1-17)
MPV: 10.7 (10-10), 11 (10-08), 9.8 (9-11), 9.7 (9-11)
RDW-SD:40.6 (10-08), 36.9 (9-11), 37.8 (9-11)
RDW-CV: 13.4 (10-10), 13.1 (10-08), 12.3 (9-11), 12.5 (9-11)
RDW, RBC: 12.9 (5-15), 13.1 (5-06), 13.2 (3-06), 13.2 (1-17)
NRBC: 0 (10-10), 0 (10-08), 0 (9-11)
Absolute NRBC: 0 (10-10), 0 (10-08), 0 (9-11)
RBC Morphology
Smudge Cells: Present
Elliptocytes/Ovalocytes: Present
CMV Viral Load, Qual: Not Detected
CMV Antibodies IgM: 106
CMV Antibodies IgG: 5.30
Mono Screen: Negative (9-22)
EBV Antibody Panel
EBV VCA IgM: Positive
EBV VCA IgG: Negative
EBV NA IgG: Negative
HIV-½ antigen/antibody: Non-reactive
Toxoplasma Gondii Antibody IgG
Toxoplasma Antibody IgG: Negative
Toxoplasma IgG Value: 0.4
Toxoplasma Gondii Antibody IgM: Negative
Hepatitis B Surface Antigen: Non-reactive
Hepatitis B Core Antibody Total: Non-reactive
Hepatitis B Surface Antibody
Hepatitis B Surface Antibody: Indeterminate
Hepatitis B Surface Antibody, Quant: 10.03
Hepatitis C Antibody Qualitative: Non-reactive
HCV Viral Load (PCR): Not detected
Antinuclear Antibody
Antinuclear Antibodies: Positive
ANA Titer: 1:160
ANA Pattern: Speckled
Double Stranded DNA: Negative at 1:10
Ferritin: 619 (10-10), 31 (1-17)
Iron and Iron Binding Capacity
Iron: 53 (10-10), 119 (1-17)
Total Iron-Binding Capacity: 257 (10-10), 432 (1-17)
Transferrin Saturation: 21 (10-10), 28 (1-17)
Haptoglobin: 232
SS-A/SS-B Antibodies
Anti-Ro Antibodies: 5.7
Anti-La Antibody: 4.5
SSA: Negative
SSB: Negative
Blood Culture: No growth at 5 days
Ehrlichia/Anaplasma PCR
Anaplasma phagocytophilum: Negative
Ehrlichia Chaffeensis: Negative
Ehrlichia Ewingii/Canis: Negative
Ehrlichia Muris Eauclairensis: Negative
T3 Free: 3.8 (9-22)
T4 Free: 0.9 (9-22), 1.3 (1-17)
TSH: 0.69 (9-11), 1.5 (05-13), 1.6 (01-17)
Lipase (9-11): 23
Urinalysis Automated UMIC
RBC (Urine): 11 (9-11)
WBC (Urine): 2 (9-11)
Squamous Epithelial (Urine): 4 (9-11)
Hyaline Casts (Urine): 1 (9-11)
Bacteria (Urine): 40 (9-11)
Urinalysis Culture Chemical Dipstick
Color (Urine): Yellow (9-11)
Clarity (Urine): Clear (9-11)
pH (Urine): 6 (9-11)
Leukocytes Esterase (Urine): Negative (9-11)
Nitrite (Urine): Negative (9-11)
Protein (Urine): Trace (9-11)
Glucose (Urine): Negative (9-11)
Bilirubin (Urine): Negative (9-11)
Specific Gravity (Urine): 1.025 (9-11)
Ketones (Urine): Negative (9-11)
Urobilinogen (Urine): 0.2 (9-11)
Blood (Urine): Negative (9-11)
Biopsy Results (10-19-2026)
Thyroid
Right thyroid mid pole nodule:
Cystic and solid
Hypoechoic
Wider than tall
Smooth margins
There are punctate echogenic foci within the nodule which are linear and appear to lie along the posterior aspect of cysts.
Additionally there are comet tails.
No microcalcifications are definitely identified.
There are 1-2 macrocalcifications.
ACR TI-RADS 4 points, TR 4
0.9 cm AP by 1.7 cm transverse by 2.1 cm SI.
Lymph Node
Left level 2 lymph node
1.1 cm in short axis by 2.3 cm in long axis
CT Scan Results
Abdomen/Pelvis (10-11-2026)
Enlarged left supraclavicular, right perihilar, retroperitoneal and mesenteric lymph nodes
Splenomegaly measuring up to 15.7 cm
Borderline mild hepatomegaly
18 mm hypodense nodule in the right thyroid lobe
Lungs: Small pleural-based nodules measuring around 4 mm in lower left lobe, along with a 4 mm nodule along right minor fissure and other small nodules along the right major fissure. Clear airways
Heart: Size is normal, small pericardial effusion. Small patent ductus arteriosus. No aortic aneurysm
Lymph Nodes: Prominent para-aortic 16x17 mm and inter aorto cava 15x15 mm lymph nodes. Additional mesenteric lymphadenopathy
Neck (10-11-2026)
Lymph Nodes: Multiple enlarged multistation cervical lymph nodes, right greater than left, with several forming nodal conglomerates, for example in the level IIb bilaterally. Nodes demonstrate relatively homogeneous soft tissue attenuation without cystic changes or calcifications. No appreciable perinodal fat stranding. Mild mass effect on adjacent structures without significant airway compromise or vascular occlusion.
Thyroid Gland: 1.5 x 1.1 x 2.1 cm (TV x AP x CC) mixed solid and cystic nodule in the right thyroid lobe. No coarse calcification. There is cervical extension of thymic tissue, reaching the level of the inferior thyroid gland
Abdomen/Pelvis (09-11-2026)
Lungs: Lung bases are clear
Liver: Normal, no mass
Spleen: Normal, no splenomegaly
Lymph Nodes: Unremarkable, no enlarged lymph nodes
Ultrasound Results (10-07-2026)
Multiple enlarged bilateral cervical lymph nodes measuring up to 3.5 cm
Mixed, solid and cystic right thyroid nodule measuring 1.9 x 2 x 1.1 cm
EKG 12 or More Leads W INT and RPT (5-15-2026)
Probably sinus bradycardia