Hey Eric!
So hearing this patient’s story… I am assuming that you are wanting to focus on the mood issue, and that this is what is most affecting his life.
a)I am not sure what to say about the EBV titers, since most young adults I know have had mono. And many kids have such mild cases that they swear they have never had mono, despite showing immunity to EBV. So, unless you tell me his titers remain super high for a long time after illness (>750 IgM and IgG) plus maybe some EA titers persisting…. I’m not too excited about this. And if EBV were an issue for him, I would expect to hear more about fatigue (not usually primary mood issues).
b)Mold exposure however can ABSOLUTELY lead to significant mood issues. I have seen happy people become frankly suicidal after a significant exposure (this would have to be in the primed or genetically susceptible human).
About the TGF-beta. Yes this can point one towards the possibility of a mold issue. However, with things like CIRS, or chronic infections, etc…. Looking at the labs, it is more as if “when I look at all of this data together, it points towards this likely being an issue”. I say this, since these labs are not specific for mold exposure.
I think that it would be a good idea to further evaluate this by
-asking history about possible water damage building exposure. And if this history isn’t looking interesting, try to see if you can figure out when symptoms started… trying to link symptoms time-wise to a change in venue, etc. I would also expect to hear symptoms of fatigue and brain fog as well.
-order mold labs that can easily be done at labcorp (without running labs that are hard to order initially).
In addition to your TGF-beta …MMP-9, MSH, VEGF. You can also look at things like ADH/osm. If all of these are off… then can get more serious about testing (will be send outs, etc)
If you really think it is mold (either from the story or from the labs…) then the biggest intervention is to get them out of this situation.
Meaning if you have $100 to spend on his care, spend all of it on getting him out of here there, before spending on treatments (I say this since even if treating him well… I think a day in a mold toxin laden environment makes someone with CIRS take more steps back than you can move them forward with treatments).
After getting him “out” I would focus treatment on:
-removal of toxins from his body (too big a topic until you know this is what is needed for this patient… but in short…. Could use CSM, Welchol, GI detox, other binders etc).
and
-calming the immune “fire”. In short this is an awesome place for TA1. Also, remember how helpful KPV can be for people recovering from mold exposures. (VIP can be very important in CIRS recovery. But not until the end of treatment, so not yet).
and
-repairing the damage done. Glia (plasmalogens) are awesome for helping repair the brain after this kind of mood change after mold.
and
-after all of the above is handled, if still with significant mood issues related to CIRS, then this is a perfect place for Ketamine to reset things (and I mean here, as mentioned in my post about a ketamine question prior … to be done IV by an anesthesiologist). Treatment course is usually 6 treatments or the like (as long as you have already handed the above. If someone needs repeated courses, then I suspect that the damage hasn’t been stopped/healed, etc yet ).
I hope hearing some of the above helps you decide some next steps for this young man. If you get more data on him, pls post it here and I’m happy to give more input.
Side note- if his symptoms came on suddenly after an illness with a sore throat…. I would certainly add PANDAS to your DDx to explore further. This would usually have started years back (but you did say “long standing”.). Anxiety and OCD from PANDAS usually has an irrational tone to their fears.
