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Enlarged Lymph Nodes Under Chin And Painless. Having Extreme Fatigue, Dizziness, Headache, Neck Ache And Low Grade Fever. Treatment?

Posted on Wed, 25 Sep 2013

Question: I've been feeling unwell for around 6 months now and for about 4 months I have several enlarged lymph nodes but not many of them, just a few specific ones. I have one large one under my chin just slightly right of center, which is round and hard and but generally painless. I have a couple more which surround that node but they are less prominent. I have noticed a few nodes on my face in front of my ear. My symptoms are extreme fatigue, lethargy, dizziness, headaches, neck aches, low grade fevers, sweats etc. Also noticed some nodules/lumps below where my tonsils were before I had a tonsillectomy 6 years ago. I think I have felt these before and though it was scar tissue from the operation but now im not so sure. I have been to my doctor several times in the last 3 months and had an ultrasound on my neck area to identify the lymph nodes and also check for enlarged salivary glands. The results just showed what we already knew and confirmed that these lumps where nodes. I've had blood tests showing my full blood cell count which was normal, thyroid, liver and renal function all normal. Recently had an antibody test for glandular fever and that came back negative. The thing is my doctor thinks this is just a regular virus and thinks I am worrying too much and thinks I am getting too anxious ( I have a history with anxiety and depression) but I can assure you I'm not worrying unnecessarily I just care about my health and want some answers, you can understand that can't you? I just wanted to know if you had any ideas what this might be, and is it worrying that I only have a select few nodes which are enlarged and painless rather than most of them being enlarged (which is what i'm more familiar with when I've been ill in the past)? Are lumps (varying in size) on the sides of my throat where my tonsils used to be, is that worrying?

Answered by Dr. Lohit K (2 hours later)

Brief Answer:
Investigations required. Sputum for AFB,Chest Xray

Detailed Answer:
Hi, Thanks for using XXXXXXX

I can understand your problem. Usually lymph node enlargement with viral infection will be painful and will disappear in 1 to maximum 2 weeks of time. Yours is pain less.

In my clinic if any of my patients comes with the complaints of palpable lymphnodes with extreme fatigue, lethargy, dizziness, headaches, low grade fevers, sweats etc I first like to rule out the following in order of priority.
1. Tuberculosis with sputum sample for acid fast bacilli and chest x XXXXXXX If positive then we can treat it using drug regimen based on the disease status.

2. If negative for TB then get done peripheral smear, ESR and lymph node biopsy to diagnose the problem.

So I advice you to get done these above said investigations as soon as possible and based on that we can manage you.
Hope I answered your question. Consult your board certified doctor for further examination and management.

Feel free to ask me if you have any further queries.
Wish you good health. Take care.

Regards

Above answer was peer-reviewed by : Dr. Mohammed Kappan

Follow up: Dr. Lohit K (43 minutes later)

Is tb a likely cause? It hadn't even crossed my mind How do you catch it?

Answered by Dr. Lohit K (19 minutes later)

Brief Answer:
Your symptoms and lymphnodes points TB.

Detailed Answer:
Hi.
Based on the symptoms you have and explanation of lymphnodes suggests TB as 1st differential diagnosis. Catching the diagnosis depends on experience also.

So get done the above said investigations and then we can plan for management.

Regards

Above answer was peer-reviewed by : Dr. Mohammed Kappan

Follow up: Dr. Lohit K (21 minutes later)

As I mentioned earlier I had my blood tested for glandular fever would any other infection show up as I was told it was an antibody test?

Answered by Dr. Lohit K (16 hours later)

Brief Answer:
Specific tests are available. Toxoplasmosis,RA,etc

Detailed Answer:
Hi,

Cross reactivity depends on the type of antibody you have been tested for. Now a days most specific antibodies will be looked for and hence very less chances of cross reaction. Patients with glandular fever commonly (85-90%) have heterophile antibodies (Paul-Bunnell test is used to detect it).

If results for heterophile antibodies are negative up to six weeks then EBV specific antibodies need to be tested. This also rules out other conditions that yield a positive result for heterophile antibodies.

The specific antibodies tested are developed against core proteins of the EB virus. These are antibodies against viral capsid antigens (VCAs) and the EBV nuclear antigen (EBNA). ELISA is done to check for these antibodies.

In general, the chance of cross reaction may be present with Toxoplasmosis, rubella, cytomegalovisrus, HIV, malaria, viral hepatitis and herpes simplex. Some blood disorders like lymphomas and rheumatoid arthritis also give positive results.

Hope this clarified and explained you about the antibody test for glandular fever and any cross reaction. Feel free to ask if any related query.

Wish you good health and faster recovery.

Regards

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Above answer was peer-reviewed by : Dr. Shanthi.E