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Differential Diagnosis Considered etiologies included: Primary psychiatric disorder Neuroinflammatory or neurodegenerative disease Endocrine dysfunction Chronic infection (Lyme disease, EBV) Chronic inflammatory response syndrome (CIRS) Environmental toxin exposure (including mycotoxins) The acute onset, lack of psychiatric history, and environmental correlation made a primary psychiatric etiology less likely

However, vulgaris class of this pant indicated excessive growth

Subacute combined degeneration of the spinal cord

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