“We have met the enemy”

John L had just completed his first year of college and was drained by its drama and “life lessons.” Like most of his classmates he ate and slept erratically and indulgently yet managed to maintain his weight and his grades. But unlike his classmates he had started to retire by 8 pm and took ibuprofen every day for joint pain. When pressed, he mentioned the near daily experience of night sweats and nausea.

When his mother and I first spoke, she was understandably concerned. I suggested that she pamper him with wholesome meals and uncontested sleep for the first two weeks of his summer break. I ordered basic blood tests to reassure her. The complete blood count was normal; liver enzymes and sedimentation rate were modestly raised. Although the story didn’t fit, I added tests for infectious mononucleosis and Lyme disease. The monospot test was negative; the Lyme titer was positive. I was perplexed that the minocycline John had been taking for his acne had not protected him. Confused, I ordered autoimmune testing and handed his care over to a colleague. She …