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Have low grade fever, irregular period, feeling fatigue. Have an arrhythmia, hypo-plastic sinus. Any idea?

DOCTOR OF THE MONTH - Jan 2013
Jan 2013
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I have had low grade fevers for 6 months along with extreme fatigue. I have just started experiencing irregular periods. I have also had a positive mono spot test, but am negative for Epstein bar. I used to have a high white blood cell count but now its normal. I also have an arrhythmia and hypo-plastic sinus, any ideas what this is?
Posted Tue, 7 May 2013 in Medicines and Side Effects
 
 
Answered by Dr. Mayank Bhargava 5 hours later
Hi XXXXXX,
Welcome to XXXXXXX forum.

Let me know your other associated symptoms along with mentioned.
Do you have cough/ difficulty in respiration/ chest pain/ watery diarrhea/ vomiting?
Do you have pain in whole body/ decreased mood/ any sleep disorders/ dark pigmentation of body?

With the available described symptoms, there could be possibility of chronic disease such as connective tissue disorder/ thyroid disorders.
Possibility of fibromyalgia should also be kept in mind.
As such there appears to be least correlation between Hypoplastic sinus and present symptoms.
Possibility of hypothyroidism appears to be high.
Presence of fatigue, menstrual irregularities, arrhythmia suggests the diagnosis.

You should consult with XXXXXXX medicine specialist and should go for thorough check up.
You should also go for complete blood count, erythrocyte sedimentation rate, thyroid profile, XXXXXXX and XXXXXXX blood sugar, serum elctrolytes, and renal function test.
You should also go for 2 D echo, electrophysiological studies of heart and holter monitoring for better clarification of arrhythmia.

Arrhythmia could be due to heart disease or due to hormonal disorders.
Hormonal disorders could be thyroid disorders, pheochromocytomas, and cushings symdrome.

Treatment depends on exact diagnosis.
Let me know the results of defined investigations.

Hope that helps.
Let me know your other query.
Take care,
Dr. Mayank Bhargava
Above answer was peer-reviewed by
 
Follow-up: Have low grade fever, irregular period, feeling fatigue. Have an arrhythmia, hypo-plastic sinus. Any idea? 29 minutes later
Hi, Dr. Bhargava,
You can call me XXXXXXX I haven't had any of those other symptoms you sugested. The only other symptoms i have had are muscle aches and weakness, headaches, dizzyness, tiredness and trouble sleeping, sore throat.

I had all those tests you sugested done already. The irregular menstraul cycle could be a side affect of the nortriptilyne medication.

The thyroid tests (TSH) were all normal at 1.3. I had a 24hr holtermonitor and they said I have rare svpcs and supreventricular tachycardia, this has been ongoing since 2009

My current CBC is normal with low MCV at 80, low MCH at 26.8, and low MCHC at 32.1

My ESR was elevated at 32 but has been higher in the past

My CRP was high at 5.4

my XXXXXXX was negative

AAT (serum) high at 208

Monoscreen positive

Glucose normal at 85

electrolytes were normal

all kidney function tests were normal, though creatinine has been slightly low in past at .63 but now is .7

bun/creat ratio was 11 in february and is now 16

Oh, also Alpha-1 globulin was highish at .3 and alpha-2 globulin was high at 1.2

let me know if i missed anything or if you want other tests, we have done alot. Thanks so much for your help and thoughts!
 
 
Answered by Dr. Mayank Bhargava 4 hours later
Hi XXXXXXX
There could be possibility of Fibromyalgia as all other defined investigations are in normal range.
You can take Amitryptiline in spite of nortryptiline.
You should also take pregabalin/ gabapentin along with methylcobalamin.
You should also go for serum Vit B 12 level and 1, 25 dihydroxycholecalciferol level.
best regards,
Dr. Mayank Bhargava
Above answer was peer-reviewed by
 
Follow-up: Have low grade fever, irregular period, feeling fatigue. Have an arrhythmia, hypo-plastic sinus. Any idea? 2 hours later
Ok, thank you. I will look into that. I did consider fibromyalgia but it doesnt fit with the fevers and the positive monoscreen. Thoughts? Also i did have b12 and that was normal
Also what about Stills disease, i have had elevated ferritin levels
 
 
Answered by Dr. Mayank Bhargava 3 hours later
Hi,
Possibility of Still's disease and other connective tissue disorder should also be kept in mind.
Elevated serum Ferritin also favors possibility of Still's disease.
Get well soon,
Dr. Mayank Bhargava
Above answer was peer-reviewed by
 
Follow-up: Have low grade fever, irregular period, feeling fatigue. Have an arrhythmia, hypo-plastic sinus. Any idea? 3 minutes later
Ok, thanks for all your help!
 
 
Answered by Dr. Mayank Bhargava 3 minutes later
Hi,
Wishing a speedy recovery.
Dr. Mayank Bhargava
Above answer was peer-reviewed by
 
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