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Swollen Lymph Nodes,headache,fatigue,protein Blood Tests
Question: I am a 29 yr old female that has 4-6 swollen lymph nodes in the left side of my neck and 1 in the back of my neck for 5 months now. Other symptoms are headache, fatigue, and sick to my stomach (on and off) more after I eat. CBC and some protein blood tests were done and they were normal. My dr said to keep an eye on them. I don't understand why someone would have these for this long with out them going away at all. What could be going on and could this be cancer.
Hello and thanks for your query.
I completely understand your anxiety and concern given what you are experiencing. One thing we have to consider in a young female with swollen lymph nodes and fatigue is something called infectious mononucleosis. This is commonly referred to as mono and is caused by a virus (EBV virus). Generally this syndrome persists for up to a few months before resolving. While this is a possibility it does not fit the time course which you describe as close to 5 months now.
Another thing we need to rule out is things which can cause swelling of lymph nodes in a localized region such as the neck. This includes skin infections, acne or dental infections. If this is not the case for you we should move on from considering that.
It also depends how large the lymph nodes are. Generally if they are smaller than 1 centimeter in diameter we don't worry too much about them as these do resolve with time.
If you feel these nodes are larger over time and still persistent now after 5 months it is reasonable to consider a biopsy. The biopsy can help us find the underlying cause and equally as important - set your mind at ease about it.
Since I saw nothing else listed I assume you are otherwise healthy, take no medications, and have no family history of any disorders or autoimmune diseases.
I think beyond 6 months it is reasonable to consider a biopsy if these nodes are persistent and large enough for a surgeon or radiologist to sample for a pathologists review. Speculating on what this could be is of no real use right now and can only cause confusion and more worry in my opinion.
I thank you again for your query. I hope you found my answer to be both helpful and informative. Should you have additional concerns I would be happy to address them.
Sincerely,
Dr. Galamaga
I completely understand your anxiety and concern given what you are experiencing. One thing we have to consider in a young female with swollen lymph nodes and fatigue is something called infectious mononucleosis. This is commonly referred to as mono and is caused by a virus (EBV virus). Generally this syndrome persists for up to a few months before resolving. While this is a possibility it does not fit the time course which you describe as close to 5 months now.
Another thing we need to rule out is things which can cause swelling of lymph nodes in a localized region such as the neck. This includes skin infections, acne or dental infections. If this is not the case for you we should move on from considering that.
It also depends how large the lymph nodes are. Generally if they are smaller than 1 centimeter in diameter we don't worry too much about them as these do resolve with time.
If you feel these nodes are larger over time and still persistent now after 5 months it is reasonable to consider a biopsy. The biopsy can help us find the underlying cause and equally as important - set your mind at ease about it.
Since I saw nothing else listed I assume you are otherwise healthy, take no medications, and have no family history of any disorders or autoimmune diseases.
I think beyond 6 months it is reasonable to consider a biopsy if these nodes are persistent and large enough for a surgeon or radiologist to sample for a pathologists review. Speculating on what this could be is of no real use right now and can only cause confusion and more worry in my opinion.
I thank you again for your query. I hope you found my answer to be both helpful and informative. Should you have additional concerns I would be happy to address them.
Sincerely,
Dr. Galamaga
Above answer was peer-reviewed by :
Dr. Radhika
Thank you for your reply.
There isn't any family history of auto-immune disorders or diseases in my family. I don't suffer from acne and I don't have any dental issues either. The only medication I take is Adderall once a day.
At times I wake up with my neck hurting, however that could be due to the way I sleep but at times I can feel a pull when I turn my neck. They at times do hurt when touched. Some of the lymph nodes are the size of a dime. I was tested for mono 5 months ago when I saw an infectious disease doctor which came back negative. I saw this doctor because I was having elevated temperatures everyday for 8 months (99.6-100.4). They never found the cause of these temperatures but they went away. He was the doctor that first noticed the lymph nodes in my neck and at every visit he would check to see if it was still there and he ruled out infection. I don't see him anymore because they wasn't a need to. Does this give more insight? And what do i do if i need a biopsy and my doctor wont order one?
There isn't any family history of auto-immune disorders or diseases in my family. I don't suffer from acne and I don't have any dental issues either. The only medication I take is Adderall once a day.
At times I wake up with my neck hurting, however that could be due to the way I sleep but at times I can feel a pull when I turn my neck. They at times do hurt when touched. Some of the lymph nodes are the size of a dime. I was tested for mono 5 months ago when I saw an infectious disease doctor which came back negative. I saw this doctor because I was having elevated temperatures everyday for 8 months (99.6-100.4). They never found the cause of these temperatures but they went away. He was the doctor that first noticed the lymph nodes in my neck and at every visit he would check to see if it was still there and he ruled out infection. I don't see him anymore because they wasn't a need to. Does this give more insight? And what do i do if i need a biopsy and my doctor wont order one?
Hello and thanks for your followup.
Has your doctor given you a timeline regarding these nodes? By this I mean he would say - we will watch for x number of weeks before proceeding with a further workup. If not, I would convey to him that you would like some kind of timeline regarding management of this.
Sometimes it is necessary in medicine to seek a second opinion. This is not to say that your doctor is not a good doctor but at times another perspective on things can provide more reassurance and possibly more clues as to what is going on. Maybe that would not be a bad idea - see a general internist who can examine you thoroughly, review all of your records, labs etc and then provide recommendations.
In your case I wonder about possibly a mild form of inflammation which could be going on. To work this up further I would consider a few things - if the fever is still present - blood cultures, also - sed rate, XXXXXXX and rheumatoid factor. Beyond that - I feel we are heading toward a biopsy.
It is a bit difficult here in the absence of being able to lay hands on you but these are my thoughts and recommendations. I hope this has proved helpful to you and as always I am here for you if you have additional concerns.
Sincerely,
Dr. Galamaga
Has your doctor given you a timeline regarding these nodes? By this I mean he would say - we will watch for x number of weeks before proceeding with a further workup. If not, I would convey to him that you would like some kind of timeline regarding management of this.
Sometimes it is necessary in medicine to seek a second opinion. This is not to say that your doctor is not a good doctor but at times another perspective on things can provide more reassurance and possibly more clues as to what is going on. Maybe that would not be a bad idea - see a general internist who can examine you thoroughly, review all of your records, labs etc and then provide recommendations.
In your case I wonder about possibly a mild form of inflammation which could be going on. To work this up further I would consider a few things - if the fever is still present - blood cultures, also - sed rate, XXXXXXX and rheumatoid factor. Beyond that - I feel we are heading toward a biopsy.
It is a bit difficult here in the absence of being able to lay hands on you but these are my thoughts and recommendations. I hope this has proved helpful to you and as always I am here for you if you have additional concerns.
Sincerely,
Dr. Galamaga
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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