Quote : EL Gato Félix
Emily Ortiz27 said:Thank you. Much appreciated.
Instead of waiting for an actual follow-up appointment with the immunologist, I stumbled upon the girl's lab results on a health portal.
This report was issued without any follow-up communication or a proper clinical review of my child. On top of that, the findings completely contradict the guidelines you provided. How do you suggest I proceed from here?
Should I just stick with the results, or reach out for a second opinion at Mayo Clinic?
I currently have an active referral for the post-COVID clinic in Miami, so I’m not entirely sure if I could even use a different referral to see the same specialist at another facility.
And who exactly should I contact over in Miami?
The little girl isn't running a fever every single day anymore. It fluctuates—sometimes she’s back to normal, sometimes it hits 98.6°F, and other times it creeps up a bit higher.
Abdominal pain persists. It’s more pronounced following physical activity.
How should we approach physical activity here? He’s training three times a week, and that doesn't even account for his regular PE classes at school.
Dear Madam,
I wrote my initial assessment based on the specific history provided: a young girl referred to a post-COVID clinic following prolonged fever, where she underwent an immunology consultation. My response was simply outlining the necessary diagnostic steps for anyone presenting with persistent fever and the specific lab results you shared.
Now that the fever has broken, my answer to that question would look quite different.
One fact remains, though: the reasoning behind ordering an ANA test. If the girl didn't have a fever at the time she saw the immunologist, the motivation for that specific lab work is unclear. It’s a well-documented phenomenon that ANA titers can spike—sometimes even reaching high levels—months after a SARS-CoV-2 infection or other viral bouts, such as mononucleosis. But you don't just run an ANA for those conditions. You order it when there is actual clinical suspicion of systemic connective tissue diseases, like lupus, lupus-related disorders, or certain autoimmune liver issues. In almost any other scenario, the test provides zero value for diagnosis or prognosis. To be blunt, it's an unnecessary expense. I fail to see why the immunologist felt this test was warranted.
Now that the test results are in—results that show a deviation—I have to wonder: which clinician looked at the clinical picture, factored in the history of a prior SARS-CoV-2 infection, and arrived at a conclusion that actually made sense? I’m circling back to my original question: what role did the ANA play in this entire diagnostic process? Why was it ordered in the first place, and how exactly did it guide the physician toward their final conclusion? I’d be interested to hear some actual reasoning on that.
Second, I have to disagree with how they handled the data—or rather, the lack of action regarding it. Specifically, the note that "abdominal pain persists and intensifies with movement." So, we have a child reporting stomach pains, yet no abdominal ultrasound was even requested? Honestly, I can't wrap my head around why.
Since things seem to be settling down and resolving on their own, most of those tests I mentioned earlier probably aren't strictly necessary. That said, if the abdominal pain persists, I’d suggest getting an abdominal ultrasound just to be safe.
Blood cultures probably aren't worth the effort at this stage. However, if that abdominal pain persists, I’d still suggest running a serum protein electrophoresis, checking the albumin/creatinine ratio from a urine sample, testing stool for occult blood three times, getting a calprotectin test, and scheduling an abdominal ultrasound. Ultimately, though, my decision would hinge on the physical exam and the clinical picture.
I can't see any images yet. Go ahead and upload the photo whenever you're ready.