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Swollen Foot, Knee Stiffness, Sore Throat, Fever. Do You Think This Could Be Chronic Brucellosis?
Question: female, age 28, 5'7, 165lbs.Iraq veteran.been treated for minor arthritis and herniations in cervical and lumbar spine.chronic muscle spasms in shoulders and neck.had bilateral compartment syndrome and treated with bilateral fasciotamies.seen in mental health for PTSD and Bipolar type 2 with psychotic features.chronic bladder infections.ultrasound of kidneys and bladder are negative.right thumb swollen at joint with pain.doctors say possible tendonitis and carpel tunnel.
approx. 3 weeks ago i had a sudden onset to include 2nd toe of right foot swollen with pain into ball of foot.purple/reddish color.left ankle swollen with pitting.both hot to touch.pain in shoulder at clavicle.it wont drop either.new symptoms 1 week ago are left knee stiffness and pain and sore throat on left side that still bothers me.Had seen a yellowish pus pocket in throat.slight fever. last night was 100.4.sed rate and reactive protein is high.immune diseases negative.rheumatoid factor negative.i am going for a bone scan this week.
do you think this could be chronic brucellosis?ive been on all kinds of meds that can have masked the symptoms.Veterans are comiing back with it What other test should my VA doctors be taking?
approx. 3 weeks ago i had a sudden onset to include 2nd toe of right foot swollen with pain into ball of foot.purple/reddish color.left ankle swollen with pitting.both hot to touch.pain in shoulder at clavicle.it wont drop either.new symptoms 1 week ago are left knee stiffness and pain and sore throat on left side that still bothers me.Had seen a yellowish pus pocket in throat.slight fever. last night was 100.4.sed rate and reactive protein is high.immune diseases negative.rheumatoid factor negative.i am going for a bone scan this week.
do you think this could be chronic brucellosis?ive been on all kinds of meds that can have masked the symptoms.Veterans are comiing back with it What other test should my VA doctors be taking?
Hello and thanks for the query.
Fisrt of all I want to thank you for serving in our military. I appreciate that very much.
Regarding your medical concerns it sounds like you have been through quite a few things and I am not sure all of them are truly related. Your most recent illness involving the swelling, pain and fever with elevated inflammatory markers is more suspicious for some kind of autoimmune phenomenon. It looks like you have had an initial workup performed which probably also included an XXXXXXX test which is kind of a general marker of autoimmune disease. Sometimes these tests could be falsely negative so we must look at the entire clinical picture.
In your case I think it may be necessary for you to see a specialist in the field of Rheumatology. Also, with the sed rate and CRP being elevated these tests can be checked again on an interval basis so that hopefully a downward trend can be identified.
Sometimes we are never able to find what triggers these types of inflammatory illnesses. Your question regarding brucellosis is a good one but your symptoms are not necessarily specific for that. You might also benefit from a visit with an infectious disease specialist who can help rule out more rare causes of such symptoms including some viruses.
I think your VA doctors should consider specialty referrals as part of your workup.
I thank you again for the query and hope this response has been informative. If you have any additional concerns I would be happy to address them.
Sincerely,
Dr. Galamaga
Fisrt of all I want to thank you for serving in our military. I appreciate that very much.
Regarding your medical concerns it sounds like you have been through quite a few things and I am not sure all of them are truly related. Your most recent illness involving the swelling, pain and fever with elevated inflammatory markers is more suspicious for some kind of autoimmune phenomenon. It looks like you have had an initial workup performed which probably also included an XXXXXXX test which is kind of a general marker of autoimmune disease. Sometimes these tests could be falsely negative so we must look at the entire clinical picture.
In your case I think it may be necessary for you to see a specialist in the field of Rheumatology. Also, with the sed rate and CRP being elevated these tests can be checked again on an interval basis so that hopefully a downward trend can be identified.
Sometimes we are never able to find what triggers these types of inflammatory illnesses. Your question regarding brucellosis is a good one but your symptoms are not necessarily specific for that. You might also benefit from a visit with an infectious disease specialist who can help rule out more rare causes of such symptoms including some viruses.
I think your VA doctors should consider specialty referrals as part of your workup.
I thank you again for the query and hope this response has been informative. If you have any additional concerns I would be happy to address them.
Sincerely,
Dr. Galamaga
Above answer was peer-reviewed by :
Dr. Yogesh D
Thank you.Yes I have had an initial workup done a few times and cyclic citrullinated peptide, nuclear AB,complement c3,c4,urate,borrellia,dna double strand,nuclear AB,thyrotropin.All test came back normal.Ive been looking on the web for weeks and I keep getting things like septic arthritis,lupus,rheumatic fever etc.Im freaking out because I have had strep so many times to even count and havent been treated most of the time.Then my mom tells me she had rheumatic fever with the joint swelling with slight or no fever.I cant help to think I have everything...Sorry I rant when Im scared... Unfortunately the VA is making it very hard for me to get a rheumatology appointment but if I have to I will go outside of the VA. I will definitely mention the infectious disease specialist.You mentioned viruses.I have HPV.Can HPV cause the random swelling and pain in my joints?Ive only been told to have regular paps to watch out for cervical cancer.
Hello and thank you for your follow-up question.
First of all I would like to make it very clear that I do not regard anything you are saying as a ranting. I realize that you have a lot of things on your mind and that you are trying to share them in a concise format. I certainly appreciate that.
Your question regarding human papilloma virus is a good one as well. I can assure you that there really is nothing that I can think of that would be need to think there is any association with that virus and the symptoms you are experiencing.
I thought of one additional thing which might be evaluated. Your doctors may also do a check of your immune system by checking immunoglobulin levels. This is something a rheumatologist. I am sorry you are finding it difficult to obtain a specialty consultation with the Veterans Administration. Rheumatologists can be hard to come by and sometimes depending on where you are. It may be more difficult.
I imagine as well that everything you are experiencing is generating at least a mild degree of anxiety. I encourage you to try to remain positive as much as possible. If you do not remain positive. It really can make recovery more difficult. I realize that exercise is probably difficult for you but I really would like to encourage you to try to make that a focus of your daily life. Even a short 15 or 20 min. walk can make a world of difference overtime.
Another thing I was thinking of today when I was reviewing your case was a possible change in diet and how that might really make an impact on how you're feeling. I am not sure if you know very much about juicing but this might be something which could be beneficial. Juicing involves the use of fresh fruits and vegetables in a machine which generates fresh juices.
These juices are full of vitamins and nutrients and sometimes can really make a world of difference for people who are suffering from problems involving joint pains and chronic ache. This is just a little side thought but I wanted to share with you.
Again I thank you for submitting your question. I hope you found my response to be helpful and informative. If you have any additional questions I would be happy to address them.
Sincerely,
Dr. Robert
First of all I would like to make it very clear that I do not regard anything you are saying as a ranting. I realize that you have a lot of things on your mind and that you are trying to share them in a concise format. I certainly appreciate that.
Your question regarding human papilloma virus is a good one as well. I can assure you that there really is nothing that I can think of that would be need to think there is any association with that virus and the symptoms you are experiencing.
I thought of one additional thing which might be evaluated. Your doctors may also do a check of your immune system by checking immunoglobulin levels. This is something a rheumatologist. I am sorry you are finding it difficult to obtain a specialty consultation with the Veterans Administration. Rheumatologists can be hard to come by and sometimes depending on where you are. It may be more difficult.
I imagine as well that everything you are experiencing is generating at least a mild degree of anxiety. I encourage you to try to remain positive as much as possible. If you do not remain positive. It really can make recovery more difficult. I realize that exercise is probably difficult for you but I really would like to encourage you to try to make that a focus of your daily life. Even a short 15 or 20 min. walk can make a world of difference overtime.
Another thing I was thinking of today when I was reviewing your case was a possible change in diet and how that might really make an impact on how you're feeling. I am not sure if you know very much about juicing but this might be something which could be beneficial. Juicing involves the use of fresh fruits and vegetables in a machine which generates fresh juices.
These juices are full of vitamins and nutrients and sometimes can really make a world of difference for people who are suffering from problems involving joint pains and chronic ache. This is just a little side thought but I wanted to share with you.
Again I thank you for submitting your question. I hope you found my response to be helpful and informative. If you have any additional questions I would be happy to address them.
Sincerely,
Dr. Robert
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Radhika
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