Question: Hi , I have been feeling weakness in body, like less energy in nerves , less energy from last 40 days and I was having joints pain mainly knee joints too thats why I noticed, I did not feel feverish thats why did not measure temp that time , when I first noticed it , I was having piles with fresh blood. Because of weakness I noticed piles because earlier also whenever I had such fatigue feeling I was having piles. But this time fatigue did not went even after piles got treated, I had consulted doctor He prescribed me tube for pile and multivitamin for 20 days. I had taken all but still fatigue it there. Then around 10-12 days before I came down with viral with got resolved but again after five days I got viral again, but from first day , I have nausea feeling in early morning, I have been having mild fever means temp is fluctuating between 97.7 early morning to 99.6 in evening, but even though temp was 98.6 but my hands palms were hot, and I could feel temp inside. This has lasted more than 10 days, I have taken 5 azithromycin, 6 ciprofloxacin, but this mild grade fever is continue, today only i did not have this fever feeling from last five hours but I am worried. Just after taking azithromycing I have loose motion means as I have anything it will come out in liquid stool form, but only after eating, and still continues even though I have loose motion issue with a very minor improvement. From many time I have been having feeling that just after doing little work muscle got feeling like I have done exercise.
For piles and blood reason I have had colonoscopy , which showed internal piles or hemorrhoids. Almost two years before I had cervical lymphadenopathy for unknown reasons , for that I met two oncologist , they had me gone for ultrasound , and report said " Multiple enlarged bilateral cervical nodes with a central fatty hilum largest measuring 20x8 mm in Level IB (submandibular region) more likely inflammatory/infective nature . II b was 9x4, III 6x2 and on left levels II- 13x5 mm flat node largest 20x4. "
I have had ultrasound follow up for two years for lymphadenopathy and for two years and it was same albeit with lymph nodes size getting reduced. Last report I had on " few cervical lymphadenopathy with maintained fatty hilum measuring less than 1 cm in short axix diameter , and all represent reactive lymphadenopathy.
For recent fever thing I have visited physician who ordered lots of test like cbc (having abnormal reading is Eosinophills 7* range 2-6) LFT was all normal , fasting sugar was in range, urine test was normal, esr was normal serum creatinine is normal, malaria is negative, hiv and hcv negative.
only abnormal finding is in xray , it showed, : Both lung fields show perihilar mild congestion" suggested clinical correlation .
Doctor my queries are
1. I have searched on internet about perihilar mild congestion and it is showing bad things only like heart failure, or metastatis ( i got worried due to lymphadenopathy), Sir what could be the reasons for this perihilar mild congestion. How serious is this? Why did I got this symptom, I had xray chest PA almost one year before and it was normal, so what has happened in this last one year. Could it be serious thing.

2. What could be possible reasons for hilar congestion , why I have this, and what are treatments?

3. Could numbness feeling be due to heart issue, and why joint pain.

4. Earlier I have had bronchitis, can it play role too?

5. Shall I go for biopsy for cervical lymphadenopathy, although for two years reports were normal and showed little reduction in size. What is your opinion.
6. Can piles cause weakness?

Doctor please answer all queries.

Hi, doctor thank you for your prompt reply. Sir can you elaborate please , are you referring CT scan with contrast and biopsy . Is it due to possibility of cancer like disease or to rule out sarcoidiosis or TB. For TB mantoux test I have done and 32 hours has passed and skin is flat albeit a little red but no hump at all. I am worried because as already I have done follow up for lymphnodes fearing cancer and thats why visited oncologist for two years every third month. They said that these are infective so I decided to go for marriage. As I have had follow up already for two years but still such bad possibilities are haunting me. Is any malignancy also possible if hilar congestion is there? Or you have suggested to rule out Sarciodiosis and TB only.

Is there any issue with heart too I need to check?

What is Connective tissue disease, and what is the full form of ANA level and profile. As my all blood test are normal so do they rule out anything?

Sorry to bother but can you please reply in a little more details and pointwise about all possibilities and possible tests. As I am being nervous it will help me out.

Hi, doctor, I am from XXXXXXX . I am non smoker and dont do any addiction too. I am worried so therefore causing you trouble , sorry for that, And my blood test , cbc , lft are normal. These lymph nodes I am having from last two years although in last ultrasound their size got reduced but not completely. Once one doctor told me as I have dandruff these wont go completely so I got relieved then but now in present condition I became worried again. And almost around one year before I had xray that was normal that time but I had lymph nodes then too. But as you have suggested I will go with biopsy. And please reply in details having considered my anxiety.

Hi, doctor, thanks for prompt reply even that late in night. My physician has went me for mantoux test for TB, and 48 hours had past and there is no hump or nothing , only minor skin is patchy. Even if mantoux test is negative, shall I go for CT scan for TB? means is there different test for TB, Does mantoux not cover it. Off course I will go for CT scan, but out of curiosity I am asking that.

Does mediastinal lymph nodes are not covered by xray? actually ct also gives too high level of xray radiation , which also is very hazardous na but If this is necessary I will go for that.

Cervical lymphnodes I have from last two years and then i did not any congestion on xay then, its new this time so will go for check up definitely. I had one ultrasound for abdomen because of fatty liver (grade 1) which I have, and rest other things were normal. This ultrasound was after one year of lymph nodes swelling case , means would not those nodes on abdomen have come by then or it can come any time.

fortunately from yesterday afternoon, I did not have fever , although palms are little warmer but temp was 98.6 at 2 pm, 97.9 at evening and 98.1 in night at 11 pm and 97.9 at early morning. Bp was 113 , 69 and heart rate was 74, but I was having feeling of strong nausea (gags only and three or four max).

Doctor sir , I will go for more follow up, for your suggested test, by tomorrow morning my blood culture reports will come. and then I will meet physician as for referring test some prescription is required.

Please give reply for above mentioned queries, for mantoux test, ultrasound for abdomen which I had this year in january, I will go for new one off course, radiation hazard , and I will have all those tests you have mentioned. Sorry for my pestering with queries and please reply these queries.