Blood test showed Cytomegalovirus infection. Having severe back pain, weak and depressed. What could be the cause?
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My mother (age mid-80s; well-controlled Type 2 diabetic for 35 years; general good health until this) has been hospitalized for three weeks. She was admitted with breathing problems. No fever but X-Ray showed pneumonia. Told that blood test showed signs of recent CMV infection but pneumonia worsened severely despite antiviral and antibiotics. When prednisone was added, lungs improved and eventually cleared up. However she is anemic. No history of anemia. Anemia returns after two blood transfusions. Complains of very severe lower back pain (has been lying down for 3 weeks). Also appears depressed, very weak, and losing interest in living. Any ideas as to underlying cause(s) of illness?
Posted Tue, 10 Dec 2013 in Blood Disorders
Answered by Dr. Prasad 11 hours later
Brief Answer: Infection + other causes... Detailed Answer: Hi, I understand at 80 years of age it would have been hard and depressing staying at a hospital. I wish her a speedy recovery. Now, about the causes of her illness: 1. CMV infection is common in immunocompromised individuals. Her age and diabetes are strong factors that would have risked her to develop CMV infection. Both these factors might also be responsible in the development of pneumonia. I am glad that pneumonia is resolved now. 2. Prolonged lying can cause musculoskeletal pain as well as bed sores. If she has no bed sores, I would prescribe physiotherapy for brief period of time before looking at other causes of back pain. 3. Anemia is sometimes noted after chronic/prolonged infection especially when a patient is only on parentral feeds. There are few indicators which can help us identify reasons for anemia. If I were to be her treating doctor, I would order and analyze complete hemogram, peripheral smear, serum ferritin level and renal functions test if the hemoglobin continues to fall after multiple blood transfusions. At this instant as doctors work on her health, it is essential that family and friend support her. Your loving care and presence can make a lot of difference psychologically and help her improve better and faster. Hope this helped. Write back if you have any other information and we can discuss further. Regards
Follow-up: Blood test showed Cytomegalovirus infection. Having severe back pain, weak and depressed. What could be the cause? 1 hour later
The doctors continue to treat for CMV; the anemia is better, but she is extremely feeble and refusing to eat. She frankly appears to be giving up, a lot of morbid ideation, even though there aren't life-threatening numbers on any tests. I told my father to see about psychiatric services.
Answered by Dr. Prasad 59 minutes later
Brief Answer: Psychiatric service to be started on need basis... Detailed Answer: Hi, I am not sure if her treating doctors would consider psychiatric service at this point of time. I wouldn't do that right away. Treatment at a hospital is governed by triage of health illness - most serious issue is treated first; the least concern the last. At this point of time, the priority is to treat all infections and associated comorbidities - blood sugar, nutrition, bed sores and others. You should discuss with her treating doctors about all the morbid conditions and make sure they are attended rightly. Psychiatrist service can be called upon when she has fairly recovered from all morbid conditions. In view of her age and pre-existing condition, recovery is going be gradual and slightly slow. Encourage and congratulate her whenever you find positive signs of recovery. Keep her motivated when she feels low. Family and friend support is as much important as doctor/nursing service in this circumstance. I would encourage you and the rest to do this as you follow the rest of her doctors treatment. I pray that she recovery very soon. Write back if you need any more information. Best wishes