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Diagnostic Assessment Inflammatory and Regulatory Markers C4a: 5600 (elevated) TGF-1: 7210 (markedly elevated) MMP-9: normal VEGF: normal MSH: normal ADH/osmolality: normal Mycotoxin Testing Elevated ochratoxin A Elevated gliotoxin Presence of aflatoxins, trichothecenes, zearalenone Lyme disease: negative Epstein Barr Virus: negative Clinical Interpretation Findings indicated: Significant toxin burden Partial inflammatory activation The absence of widespread biomarker abnormalities suggested a non-CIRS mycotoxin illness with immune involvement