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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

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Subacute combined degeneration of the spinal cord