Question: Hi, Doctor. I have been going through a lot of testing to try to determine the cause of extreme fatique and activity intolerance. I feel like I have suddenly become very out of shape - for instance, just dressing makes me tired and winded, while the process of showering and drying my hair, etc makes me completely exhausted for the rest of the day. Just last Autumn, I was bike riding, hiking, and feeling in goood health. My symptoms of exhaustion have been happening for about 3-4 months now. With activity, my heart rate is also very elevated - but, directly proportional to the level of activity.



I have also had a 27 lb unintentional weight loss in the last 6 months. At first, I had decreased appetite and wasn't eating much. I still have decreased appetite but I have been trying everything to gain weight (consuming so many calories) and I am still losing weight.



I am having other less severe symptoms which I will list below.



I am attaching my most recent labwork - it does not show my ferritin level of 4.



You will see that my Anti-nuclear Antibody results were abnormal I also had a CT of the Chest/Abdomen/Pelvis yesterday to look for any cancer and I just read that an abnormal ANA can sometimes be the result of cancer. The results of the test were "AN IG Antibody Screen - Positive, Anti-nuclear Antibody Titer - 1:80, Pattern - Atypical/Speckled."



Other symptoms:



- achy joints (worse a year ago but ANA was normal then)

- cold extremities (often one hand will be very cold, while the other is normal - no discoloration or pain)

- occasionally feeling suddenly hot (for a couple of minutes) but, most of the time I am cold.

- pressure behind eyes (hard to describe - feels like pressure in eye sockets)

- occasional low grade fever (99.8- 101.2) in the evening - for up to a week at a time)

- activities are much harder to do in the mornings

- hair Is falling out - in shower, sink, on bathroom floor (but is not on pillow or anything). It does seem a little drier too.

- drier than normal eyes (use eye drops a few times a week now and contacts are harder to remove)

- nails are more brittle, especially on feet

- I've often experienced an unexplained rash throughout my adult life (maybe 4-5 times a year). One ear will swell, become warm to touch and red, and then I will develop about 4 red splotches on my neck and/or upper chest. It will last for about 1-2 hours.

- muscles feel weak with activity or standing. (Legs and arms feel very heavy)

- I'm falling asleep well, but waking easily with trouble going back to sleep. (very unusual for me)

- memory problems and some difficulty remembering words at times (when talking)



Sorry for the long message. I am trying to provide as much information as I can about my symptoms because they are all so strange to me. Do you have any ideas about what this could mean and if any further testing is needed? Thank you so much for your advice and input!

Thank you, Dr. Agarwal! I was wondering, how the unintentional weight loss, despite consuming many more calories than should be needed, would fit into fibromyalgia or chronic fatigue syndrome. Also, I left out another big unusual thing that began to occur as these symptoms emerged 3 or so months ago. (It's one of the main confusing things - I don't know how I left it out!) My blood pressure has become very low lately. Much of the time it is a low normal (102/60 or so) but many times it gets down even lower (84/56 or so). This is very unusual for me because I have never had low BP - even when I was a young, very healthy athlete. It has always run around 126/84 or so. I don't have signs of dehydration - not phyically (I'm drinking fine, my urine is clear / light yellow and often, my skin is normal) and also not indicated on any lab results. Does this give any additional insight into what might be the problem? Does chronic fatigue or fibromyalgia still seem to be the most likely diagnosis? (knowing that organic disease needs to be ruled out, of course) If so, could you please explain how the weight loss despite consuming plenty of calories and the low blood pressure would be related? Those are the very physical manifestations which i just can't understand. Thank you so very much for your help and knowledge!

Thank you!