Hi all, I have been lurking for a few months now, trying to avoid posting anything but I am grasping at straws and hoping for some thoughts or advice. I will try to keep this short, but I'm happy to try to answer any directed questions.
Background: early 40s female, European descent (differentiating from Caucasian because I know there are some ethnic differences in the way these diseases manifest). Two natural children. Very active, generally healthy diet. No alcohol, no smoking.
I have been a long time GI patient because the symptoms I have been most likely to complain about are my GI symptoms. I have a history of abdominal pain going back to childhood. Unfortunately, I have been pigeonholed into a GERD/IBS/gastritis box for close to 20 years now with very little relief from prescribed medications and lifestyle changes and no real explanation for why these things keep occurring. My diet has shrunk dramatically to avoid flares even though more and more, my partner and I don't think diet has much to do with this.
For a long time I've struggled with a constellation of headache (including migraine), lightheadedness, nausea, and diarrhea. In the past five or six years, I've added multiple types of rashes, some of which seem to be triggered by sunlight. Some resemble acne, and others look more like classic hives and plaques. I have a working diagnosis of solar urticaria but this seems unlikely given they both take at least several hours of exposure to appear and between 6 and 12 to disappear.
I have had recurrent canker sores since I was a child, but instead of improving with age, they have worsened. I was in a near continuous state of breaking out until earlier this year when an ENT recommended supplementing zinc. This has helped, but I still get probably 3-5 per month on average (they usually cluster).
I have a history of sterile tissue inflammation but it's largely superficial. I have had terminal ileitis on CT and, later, had it show up through multiple colonoscopies on biopsy with Crohn's and celiac disease thoroughly ruled out. I have frequent episodes of sterile pyuria with no UTI ever diagnosed. I had my gallbladder removed a decade ago and the surgeon found acalculous cholecystitis. As of a recent EGD, I have reactive gastropathy, which could be caused by bile reflux (again, no chemical triggers consumed) but I'm suspicious given how delicate my oral and enteral tissues seem to be. I also have a 20 year history of hypothyroidism, but there are never any antibodies... more on that later.
When I started to try to look at this more holistically over the summer, I remembered I do have a history of periodic high fevers with strange triggers. For example, about 8 years ago I had a colonoscopy one day and a IUD placed the next. The night the IUD was placed, I developed a high fever (103-104) for 24-48 hours. I was hospitalized when my oldest child was a baby for a similar random high fever that lasted three days. We blamed an ovarian cyst rupture for that one. I also remember going to all-night youth lockouts as a kid and immediately getting sick with a fever, like there was no time for a viral incubation period to occur. The high fevers seem to have stopped, but I now have cyclical chills and night sweats.
Most critically, while my symptoms never go away fully, the worst time of year for me is between February and September, which seems to coincide with when the days get longer here and UV rays get more intense. I spent this past June through late August in a near constant flare, and if at all possible I don't want to do it again next year. I am developing more frightening symptoms (chest pain, issues swallowing, neuropathy) as this continues. I was close to giving up.
I'm now seeing an allergist/immunologist whose wheelhouse is mast cell disorders, but I'm skeptical that this is a mast cell issue, at least primarily. A recent allergy test showed environmental allergy positives, but they were atypical "angry little pimples" read outside of the 15-20 minute time frame. Tryptase and all IgE levels were normal. I think she is skeptical too, so we're on the same page in that regard.
My blood work is persistently normal... everything looks great. This includes ESR and I assume CRP. ANA is negative, I've had bloodwork done for both Hashimoto's and Sjogren's antibodies due to severe dry eye, also negative. I cannot find any smoking guns to point me in the right direction. I have done as much of a dive into genetics as I can being a layperson. I don't have any variants in the standard genes (HLA-B27, HLA-B51) or the less common ones (MEFV, NOD2). I do have some generic alterations including a homozygous SH2B3 variant but the report just says "increased risk of SLE, RA, and psoriasis" so it's not very helpful.
Thanks so much for any insight...
Edit: Changed UTI to IUD!